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THE   CAUSATION   OF   SEX 
IN   MAN 


THE 

CAUSATION  OF  SEX 

IN  MAN 

A   NEW  THEORY  OF  SEX  BASED  ON   CLINICAL   MATERIALS 


TOGETHER   WITH    CHAPTERS    ON 


FORECASTING  OR  PREDICTING  THE  SEX 
OF  THE  UNBORN  CHILD 


AND   ON    THE 


DETERMINATION    OR    PRODUCTION 
OF  EITHER  SEX  AT  WILL 


By 
E.    RUMLEY    DAWSON 

L.R.C.P.  LOND.  ;    M.R.C.S.  ENGLAND 

LATE    MEMBER   OF   THE   COUNCIL   OF   THE    OBSTETRICAL   SOCIETY   OF    LONDON 

AND    FELLOW   OF   THE   ROYAL   SOCIETY   OF   MEDICINE 

FORMERLY   RESIDENT  OBSTETRIC   HOUSE    PHYSICIAN   TO   THE   WESTMINSTER    HOSPITAL 


'*OMNE  VIVUM  AB  OVO 


PAUL  B.   HOEBER 

67  &  69  EAST  59TH  STREET 

NEW  YORK 

1917 


238123 


Printed  m  England 


TLo   tbe   /IDemor^ 

OF 

A  MEDICAL  MARTYR 

THE    LATE 

IGNATIUS  P.  SEMMELWEIS 

FORMERLY   OBSTETRIC   ASSISTANT   TO   THE   VIENNA   HOSPITAL 

THIS  BOOK  IS  DEDICATED 


AS  A  RESULT  OF  PROPOUNDING  AND  ADVOCATING  A  THEORY  OF 
THE  CAUSATION-  OF  BLOOD-POISONING  DURING  CHILDBIRTH,  NOW 
UNIVERSALLY  ADMITTED  TO  BE  CORRECT,  BUT  NEW  THEN  AND 
THEREFORE  DISBELIEVED,  HE  WAS  DESPISED  AND  RIDICULED 
BY     HIS     COLLEAGUES     AND     TEACHERS,     FINALLY     DYING     INSANE 

A  VICTIM 

TO    THE    RELENTLESS    PERSECUTION    AND    CONTEMPTUOUS 
OPPOSITION    TO    WHICH    HE    WAS    SUBJECTED 


ruERE    IS    NOTHING    MORE    THANKLESS    THAN    THE    ATTEMPT    TO    INFLUENCE    ANY    FIELD 
OF    PUBLIC    OPINION." 


PREFACE  TO  THE  SECOND  EDITION 

The  preparation  of  this  new  edition  has  enabled  me  not 
only  to  revise  it,  but  to  explain  and  elucidate  some  of  the 
difficulties  experienced  by  my  readers. 

I  have  therefore  included  many  more  cases,  and  examples 
explanatory  of  different  points  have  also  been  added. 
In  order  to  do  this  and  yet  keep  the  volume  nearly  to  its 
original  size,  some  matter  not  strictly  relevant  to  the  chief 
subject  of  the  book  has  been  omitted. 

Further  experience  and  testing  of  the  theory  have  led 
to  but  little  alteration  or  modification  of  the  conclusions 
therein  contained.  The  book  has  not  only  shown  members 
of  my  own  profession  how  to  determine  the  sex  of  the 
next  child  for  some  of  their  patients,  but  that  I  had 
also  succeeded  in  making  the  book  comprehensible,  and 
practically  useful  to  the  intelligent  layman,  is  evident 
from  the  receipt  of  many  grateful  letters  from  readers  of 
the  book,  previously  quite  unknown  to  me;  I  therefore 
hope  that  this  revised  edition  will  be  more  than  ever  helpful 
to  all  who  desire  to  exercise  a  reasoned  control  over  the 
sex  of  their  offspring. 

The  appearance  of  this  new  edition  now  must  be  deemed 
most  opportune,  for  owing  to  the  abnormally  heavy  drain 
on  the  manhood  of  the  country,  the  birth  of  sons  to  the 
nation  becomes  an  Imperial  necessity.     And  here  I  wish  to 

vii 


viii         PREFACE  TO  THE  SECOND  EDITION 

point  out  once  again,  that  those  who  desire  to  study  the 
Human  Family  must — as  was  stated  in  The  Mendel  Journal 
— "  quit  the  experimental  garden  and  cloister,  and  pass  out 
into  the  world  of  his  fellows  ";  for  from  his  fellow-creatures, 
rather  than  the  invertebrata  and  plants,  will  he  learn  the 
details  and  mysteries  of  human  families,  and  so  gather 
confirmation  of  the  views  expressed  in  this  book. 


E.  RUMLEY  DAWSON. 


The  Elms, 

Teddington, 
jNIiddlesex. 


PREFACE  TO  THE  FIRST  EDITION 

I  HAVE  written  this  book,  not  as  the  outcome  of  a  sudden 
inspiration  or  guess,  but  as  the  result  of  prolonged  and 
careful  study;  hence  I  trust  the  reader  will  form  his  con- 
clusions thereon  only  after  careful  perusal  of  it. 

The  problem  of  the  Causation  of  Sex  in  Mankind  has 
always  been  a  fascinating  one,  and  only  recently  it  has  been 
described  as  ''on  the  borderland  of  the  insoluble." 

Some  hitherto  insoluble  questions  have  been  solved,  for 
example,  by  Marconigrams,  Radiograms,  and  Submarine 
Warships;  others  are  being  assailed,  for  both  Arctic  and 
Antarctic  expeditions  are  attempting  to  solve  the  Polar 
question,  while  the  conquest  of  the  air  by  aerial  machines 
and  dirigible  balloons  will  not  apparently  be  long  delayed. 

Such  examples,  therefore,  encourage  the  attempt  to  solve 
the  question  of  the  Causation  of  Sex,  and  supply  a  valid 
reason  for  the  production  of  my  book,  the  more  especially 
as  I  claim  to  have  discovered  Nature's  secret. 

This  theory  is  built  up  essentially  on  clinical  material 
and  facts,  and  thus  differs  from  Schenk's  theory,  which 
recently  startled  the  world.  The  latter  looked  like  an 
attempt  to  give  a  scientific  flavour  to  the  old  nursery 
rhyme  that — 

"  Sugar  and  spice  and  all  things  nice, 
That  is  what  girls  are  made  of." 

It  was  never  seriously  credited,  however;  for  by  the  applica- 
tion to  Schenk's  theory,  or  rather  hypothesis,  of  the  one 


X  PREFACE  TO  THE  FIRST  EDITION 

well-known  clinical  fact  of  the  occasional  simultaneous 
birth  of  both  a  boy  and  a  girl,  it  was  at  once  shown  to  be 
quite  untenable. 

In  the  chapter  on  the  Determination  of  Sex  I  have  given 
general  rules  only,  as  each  individual  case  must  be  separately 
worked  out,  preferably  by  the  person's  own  private  medical 
attendant. 

Of  the  illustrations,  nine  are  new  and  original.  The 
source  of  the  remainder  is  given  in  the  text:  all  have  been 
redrawn,  and  some  have  been  modified  or  simplified  so  as 
to  render  certain  points  clearer  to  the  reader;  while  for  the 
loan  of  Figs.  14  and  21,  taken  from  Bland-Sutton  and  Giles' 
"  Diseases  of  Women,"  I  have  to  thank  Mr.  Bland-Sutton 
and  his  publishers,  Messrs.  Rebman,  Ltd. 

For  many  of  the  facts  used  I  am  indebted  to  others; 
the  fitting  of  them  into  the  mosaic  of  the  theory  I  claim 
to  be  my  own. 

E.  RUMLEY  DAWSON. 


CONTENTS 


CHAPTER  PAGE 

INTRODUCTION       -                  -                  -                  ---  I 

I.    THE    ANATOMY    OF    THE    FEMALE   GENERATIVE    ORGANS    -  5 

II.    PHYSIOLOGY  OVULATION  THE     CORPUS     LUTEUM 

PUBERTY MENSTRUATION THE    MENOPAUSE                    -  1 7 

III.  THE   FORMATION    OF    OVA  -  -  -  "32 

IV.  THE   FORMATION    OF    SPERMATOZOA              -                  -                  -  36 

V.    FERTILISATION       -                  -                  -                  -                  -      ,            -  38 

>     VI.    THE    THEORY    AND    ITS    EXPLANATION,    TOGETHER'  WITH 

SOME    CONFIRMATORY   VIEWS     -                  -                  -                  -  46 

;   VII.    DOES  THE  MALE  PARENT  OR  FATHER  INFLUENCE  S^EX  ?      -  56 

VIII.    CASES      OF     UTERINE     PREGNANCY     WHICH     PROVE     THE 

THEORY                 _                  _                  -                  >                  -  63 

IX.    CASES     OF     EXTRA-UTERINE    PREGNANCY    WHICH    PROVE 

THE   THEORY     -  -  -  -  -  "67 

X.    CASES      OF      PREGNANCY      AFTER      OPERATIONS      ON      THE 
OVARIES,   WHICH    PROVE   THE   THEORY  AND    SHOW  THE 

EFFECT    ON    CHILDBEARING    OF    SUCH    OPERATIONS        -  76 

XI.    CASES      OF     PREGNANCY     IN     ABNORMAL     UTERI     WHICH 

PROVE   THE   THEORY       -                  -                  -                  -                  -  82 

XII.    THE    CORPUS    LUTEUM    AS    A    SIGN    OF    PREGNANCY               -  86 

XIII.  THE  MIGRATION  OR  TRANSMIGRATION  OF  OVA  -  -  90 
XIV.    PREGNANCY    IN    THE    MAMMALIA  -                  -                  -                  "97 

XV.    WHY    MORE    BOYS    ARE    BORN    THAN    GIRLS               -                  -  IO5 

xi 


xii  CONTENTS 

CHAHTKR  PAOB 

XVI.    THE  INFLUENCE  OF  LATERAL  DECUBITUS  ON  THE  DETER- 
MINATION   OF   SEX  -  -  -  -  -115 

XVII.    THE   PROPORTION   OF  THE  SEXES   IN   INDIVIDUAL  HUMAN 

FAMILIES  -  -  -  -  -  -122 

XVIII.    MULTIPLE    CONCEPTIONS    OR   PLURAL    PREGNANCY                -  I32 

XIX.    DOES  A  DISEASED  OVARY  LEAD  TO  DISEASED  CHILDREN  ?  1 46 

XX.    HERMAPHRODITISM                -----  154 

XXI.    CASES    THOUGHT   TO   DISPROVE   THE   THEORY         -                  "  ^57 

XXII.     THE   ALTERNATE   ACTION    OF   THE    OVARIES             -                  -  I7O 

XXIII.  THE   FORECASTING   OR   PREDICTION   OF   THE   SEX   OF   THE 

COMING   CHILD                   -----  i8l 

XXIV.  DIFFICULTIES    AND    SOURCES    OF   ERROR   EXPLAINED          -  I97 

XXV.    A   CONSIDERATION    OF    THE   PRE-   AND    POST-MENSTRUAL 

THEORY    OF   SEX    DETERMINATION          -                 -                  -  2o8 

XXVI.    THE    DETERMINATION    OR    PRODUCTION    OF    EITHER   SEX 

AT   WILL                ......  '2l4^ 

INDEX       ------                   -  221 


LIST   OF    ILLUSTRATIONS 

VIG.  PACK 

I  AND  2.    VIRGIN   AND    MULTIPAROUS   UTERUS                    -                 '  5>  ^ 

3.  FRONT  VIEW  OF  UTERUS  IN  RELATION  TO  SURFACE  OF  BODY  8 

4.  ABNORMAL   UTERI       -                  -                  -                  -                 -                  -  lO 

5.  POSTERIOR   VIEW    OF    OPENED    UTERUS,    OVARIES,    ETC.           -  I3 

6.  OVARY    SHOWING    FOLLICLES    CUT    ACROSS    AND    ONE    JUST 

RUPTURED                  -                  -                  -                  -                  -                  -  15 

7.  GRAAFIAN    FOLLICLE,    CONTAINING    NEARLY    RIPE    OVUM         -  1 5 

8.  OVULATING   OVARY,    MAGNIFIED    SECTION      -                  -                 -  18 

9.  CORPUS    LUTEUM         -                  -                  -                  -                  -                  "  ^9 

10.  A   HUMAN    OVUM          -                  -                  -                  -                  -                  -  34 

11.  HUMAN    SPERMATOZOA               -                  -                  -                  -                  "  3^ 

12.  A      HUMAN      OVUM,      SHOWING     ITS      UNIVERSALLY      POROUS 

CELL-WALL                 -                  -                  -                  -                  -                  -  4O 

13.  AN    INVERTEBRATE    OVUM,    SHOWING   THE    MICROPYLE             -  4I 

14.  A     RECENTLY     PREGNANT     FALLOPIAN     TUBE     AFTER     COM- 

PLETELY   ABORTING.      CORP.US    LUTEUM    IN    THE    OVARY  88 

15.  sheep's   UTERUS,    UNOPENED               -                   -                  -                  '97 
I5A.    sheep's    uterus,    OPENED                  -                   -                  -                   -  98 

16.  PREGNANT   COW's   UTERUS,    SHOWING   BULL-CALF   IN    UTERO 

facing  1 01 

17.  PREGNANT     SHEEP's     UTERUS,     SHOWING     TWIN     LAMBS     IN 

UTERO          -                  -                  -                  -                  -                  -                  -  102 

xiii 


xiv  LIST  OF  ILLUSTRATIONS 

riG.  PAGE 

1 8.  POSTERIOR  VIEW  OF  UTERUS  IN  SITU,   SACRUM  REMOVED      -  Il6 

19.  RIGHT-SIDED  SALPINGITIS  CAUSING  RIGHT-SIDED  STERILITY  1 25 

20.  POSTERIOR  VIEW  OF  UTERUS,  SHOWING  SITES  WHERE  ACCES- 

SORY   OVARIAN   TISSUE   MAY   BE   FOUND   -  -  -  160 

21.  FRAGMENT  OF  OVARY  CONTAINING  A  CORPUS  LUTEUM  AFTER 

SUPPOSED  COMPLETE  REMOVAL  OF  BOTH  THE  OVARIEiS,  ETC.  1 65 


THE 

CAUSATION  OF  SEX  IN  MAN 

INTRODUCTION 

Early  in  the  year  1887  my  attention  was  first  called  to  the 
fact  that  the  great  problem  of  the  Causation  of  Sex  in 
Mankind  was  still  unsolved. 

The  inquiries  which  I  then  began  to  make  soon  showed 
me  how  much  in  the  dark  the  medical  profession  is  on  the 
subject. 

The  whole  question  of  the  Causation  of  Sex  in  Mankind 
had  been  hedged  around,  encumbered  and  obscured  with 
observations  ad  nauseam  on  the  eggs  of  the  invertebrata ;  on 
worms  and  tadpoles;  on  sponges,  and  plants;  on  bees,  and 
water-fleas;  and  lastly,  on  hens'  eggs,  to  which  nothing  more 
dissimilar  could  be  found  than  the  human  eg^  or  ovum. 

If  ever  it  be  true  that  ' '  the  proper  study  of  mankind  is 
man,"  it  is  in  this  study  of  the  causation  of  sex,  and 
therefore  I  have  made  it  chiefly  a  clinical  study . 

Among  the  large  number  of  theories  which  had  been  ad- 
vanced, the  great  majority  were  quite  untenable,  and  were 
propounded  without  any  clinical  evidence  or  facts  to  support 
them;  several  others  I  found  had  been  suggested  which 
were  diametrically  contradictory  to  a  theory  which  some 
former  writer  had  advocated.  A  few  of  these  I  mention 
in  the  text. 

As  a  general  practitioner  of  medicine,  the  daily  round  of 
work,  the  ever-present  necessity  of  earning  one's  living, 
sadly  interfered  with,  and  was  hardly  conducive  to,  close 
study  of  and  inquiry  into  such  an  engrossing  subject,  and 
so  progress  was  slow ;  but  we  must  remember,  as  Dr.  Samuel 


2  THE  CAUSATION  OF  SEX 

Johnson  said,  "  it  is  dangerous  to  quiet  our  uneasiness  by 
the  delusive  opiate  of  hasty  persuasion  ";  for  the  answers 
to  most  great  questions  have  only  been  arrived  at  after  much 
patience  combined  with  persistence  and  sustained  work. 

It  was  not,  therefore,  till  some  thirteen  years  after  first 
beginning  the  study  of  the  Causation  of  Sex  that  I  ventured, 
in  December  1900,  to  bring  the  subject  before  the  Obstetrical 
Society  of  London :  it  is  remarkable,  but  it  was  the  first  time 
that  the  subject  of  the  Causation  of  Sex  in  Mankind  had  ever 
been  discussed  by  the  Society !  Innovations,  however, 
rankle  with  many,  and,  as  was  to  be  expected,  but  little 
knowledge  of  the  subject  was  shown,  and  much  of  the  criti- 
cism of  the  paper  was  irrelevant  and  inaccurate. 

The  reception  of  the  paper  did  not  discourage  me,  and 
the  following  eulogistic  notice  of  it  from  the  pen  of  the 
then  President  of  the  Obstetrical  Society,  Mr.  Alban  Doran, 
F.R.C.S.,  appeared  in  vol.  xliii.  1901,  pp.  49  and  50,  of  the 
Society's  Transactions : 

"  A  very  remarkable  monograph  on  '  The  Essential  Factor 
in  the  Causation  of  Sex:  a  New  Theory  of  Sex,'  was  read  in 
December  by  Mr.  E.  Rumley  Dawson.  This  communication 
was  prepared  after  long  study  of  cases  of  removal  of  one 
ovary,  and  of  families  where  one  sex  predominated  or 
prevailed  entirely.  .  .  .  The  boldest  theory  in  this  singular 
monograph  was  the  assertion  that  the  sex  of  the  child 
depends  upon  which  ovary  supplied  the  ovum  fertilised. 
This  paper  was  strongly  criticised  in  a  very  active  discussion 
by  several  obstetrical  and  gynaecological  authorities;  but 
the  author,  who  showed  great  dialectical  ability  both  in  his 
written  monograph  and  in  his  reply  to  his  critics  at  the 
meeting,  stoutly  maintained  the  scientific  value  of  his  views. 
This  memorable  discussion  on  a  sex  problem — a  subject 
always  of  interest,  though  on  the  borderland  of  the  insoluble 
—was  further  remarkable  as  being  the  last  piece  of  work 
done  by  the  Obstetrical  Society  in  the  nineteenth  century.*' 

Having  thus  led  the  way,  I  continued  to  note  and  observe, 
and  the  gradual  collection  of  facts  and  cases  stimulated  me 
to  further  efforts,  for  I  found  new  patients  and  new  cases 
supplying  almost  daily  fresh  points  or  facts  with  which  to 
build  up  and  maintain  my  theory. 


INTRODUCTION  3 

Each  individual  fact  brought  forward  in  support  of  my 
theory  may  have  no  great  force  by  itself,  yet  when  we  come 
to  add  together  the  separate  facts,  the  number  of  points  in 
favour  of  the  theory  form  in  the  aggregate  proof  so  con- 
vincing as  to  leave  very  little  room  for  doubting  its  accuracy. 

The  present  book,  then,  is  the  result  of  this  further  study ; 
the  original  paper  is  incorporated  with  it,  the  whole  has 
been  rewritten,  and  the  additions  thereto  more  than  equal 
the  original  observations. 

I  have  throughout  endeavoured  to  support  and  sub- 
stantiate every  statement,  proposition,  or  conclusion,  either 
by  extracts  from  well-known  authorities  or  by  clinical  cases, 
and  thus  gradually  to  build  up  the  theory  on  ascertained 
facts;  but  no  one  save  those  who  have  hunted  up  cases  in 
medical  literature  can  be  aware  of  the  great  difficulty  experi- 
enced in  finding  perhaps  the  very  item  or  fact  we  are  looking 
for.  In  this  way  scores  of  cases  which  might  have  been 
used  are  found  to  be  useless  owing  to  the  remarkable  manner 
in  which  authors  have  failed  to  note  the  sex  of  the  child 
born,  or  from  which  side  an  ovary  was  removed,  or  in  which 
half  of  a  double  uterus  the  child  was  contained.  I  have 
had  most  exasperating  experiences  in  this  way,  and  writing 
personally  to  the  authors  has  been  no  more  successful: 
thus,  in  one  case,  though  the  weight  of  the  child  is  given, 
and  a  careful  dissection  was  made  of  its  heart,  its  sex  was 
unaccountably  omitted;  in  others  we  get  the  weight  and 
length,  but  no  sex ;  and,  finally,  a  case  is  described  of  open- 
ing the  mother's  abdomen,  removing  a  living  child,  elaborate 
measurements  of  its  head  are  given,  but  though  the  ovaries 
were  removed,  they  are  not  described,  neither  is  the  sex  of 
the  child  given  ! 

I  have  thus  found  my  investigations  repeatedly  hampered 
by  incomplete  records,  hence  the  number  of  cases  is  less 
than  it  might  have  been. 

I  have  claimed,  and  repeat  my  claim,  that  my  theory  is  a 
new  one:  in  dissociating  as  I  do  the  male  parent  from  any 
influence  in  sex  causation,  my  theory  essentially  differs  from 
those  old-world  theories  which  some  critics  thought  were 
similar.  Further,  I  prove  my  theory  practically  and  with 
clinical  material;  no  attempt  has  prc\'iously  been  made  to 


4  THE  CAUSATION  OF  SEX 

utilise  the  sexually  differing  families  daily  met  with;  and 
such  subjects  as  extra-uterine  pregnancy;  pregnancy  in 
abnormal  uteri;  multiple  pregnancy;  the  migration  of  the 
ovum ;  and  why  more  boys  are  born  than  girls ;  are  all  used 
to  prove  the  Causation  of  Sex  in  Mankind  for  the  first  time. 

Confirmation  of  the  correctness  of  the  theory  is  practically 
shown  by  my  being  able  not  only  to  forecast  the  sex  of  the 
coming  child,  but  also  to  determine  either  sex  at  will. 

I  have  endeavoured  to  give  chapter  and  verse  for  most 
quotations  and  cases.  I  am  well  aware  of  faults  in  the  book, 
but  I  must  claim  the  reader's  indulgence,  for,  apart  from 
the  claims  of  my  daily  work,  which  often  rendered  it  im- 
possible for  several  days  and  weeks  together  to  either  write 
or  study,  the  mere  collection  of  so  many  cases  necessarily 
prevents  the  narrative  running  along  in  the  smooth  way 
one  might  wish;  but  they  were  essential  to  prove  the  theory. 

And  again,  in  order  to  emphasise  the  different  points  I 
have  had  to  utterly  disregard  repetition:  emphasis  requires 
repetition,  and  hence  I  fear  the  narrative  suffers  thereby. 

The  absorbing  interest  of  the  subject,  however,  will  over- 
ride the  literary  deficiencies,  for  that  the  subject  of  sex  is  of 
the  greatest  interest  and  importance  is  surely  indisputable; 
and  all  must  agree  with  Havelock  Ellis  when  he  says  that — 

"Sex  is  the  central  problem  of  life." 


CHAPTER  I 

THE  ANATOMY  OF  THE  FEMALE  GENERATIVE 

ORGANS 

A  COMPLETE  anatomical  description  of  the  whole  of  the 
female  generative  organs  being  beyond  the  scope  or  necessi- 
ties of  this  book,  only  the  following  abbreviated  account  of 
the  internal  organs  essential  to  reproduction  will  be  given. 
The  Uterus  or  womb  is  roughly  a  pear-shaped  muscular 
organ,  containing  a  small  cavity  which  is  capable  of  much 


FUNDUS  OF  UTERUS 


UTERINE  OPENING  OF 

FALLOPIAN  TUBE 

WHICH  IS  CUT 


CAVITY 
OF  CtRVIX 


Fig.  I. — Front  View  of  Virgin  Uterus. 

A.  Unopened.     B.  Opened,   by  removal  of  anterior  wall,   showing  its  cavity. 

dilatation.  It  is  situated  within  the  bony  pelvis,  to  the 
walls  of  which  it  is  attached  or  slung  by  folds  of  peritoneum, 
known  as  the  broad  ligaments.  These  pass  outwards,  like 
outstretched  wings,  from  the  sides  of  the  uterus,  and  so 
form  suspensory  ligaments  for  it.  In  front  of  the  uterus 
is  the  bladder,  while  the  rectum  or  last  portion  of  the  bowel 
is  behind  it. 


6  THE  CAUSATION  OF  SEX 

The  uterus  is  freely  movable,  and  consists  of  a  body, 
the  upper  larger  portion,  triangular  in  shape,  and  a  cervix 
or  narrowed  cylindrical  portion  which  projects  down- 
wards into  the  upper  part  of  the  vagina  or  external  genital 
passage. 

The  uterus  varies  in  size  slightly  in  different  women,  and 
considerably  whether  it  be  in  a  virgin  or  multiparous  state. 


CORNU 


UTERINE  CORNU  OR  HORN 


CUT  END  OF 
FALLOPIAN  TUBE 


CAVITY  OF  BODY 


EXTERNAL  OS 


Fig.  2. — Uterus  of  Woman  who  has  Borne  Children. 

Anterior  wall  removed  to  show  cavity. 


The  position  of  the  body  of  the  uterus  is  such  that,  as 
Play f air ^  says: 

"  The  body  of  the  uterus  is  very  generally  twisted  somewhat 
obUquely,  so  that  its  anterior  surface  looks  a  little  towards  the 
right  side." 

This  facing  towards  the  right  side  by  the  anterior  surface  of 
the  uterus  leads  to  the  left  side  of  the  uterus  being  carried  to 
the  front,  so  that  when  the  woman  is  in  the  dorsal  position, 
or  lying  flat  on  her  back,  the  right  ovary  and  the  uterine 
opening  of  the  right  oviduct  or  Fallopian  tube  are  lower  in 
the  pelvis  than  the  left. 

1  Playfair.  "  The  Science  and  Practice  of  Midwifery,"  1898,  p.  33. 


ANATOMY  OF  FEMALE  CxENERATIVE  ORGANS      7 

Spiegelberg^  says: 

"  The  uterus  is  not  only  inclined  forwards,  but  almost  always 
towards  the  right  side  also,  while  the  left  side  is  rotated  forwards, 
a  position  caused  mainly  by  pressure  of  the  rectum  during  develop- 
ment, and  by  the  weight  of  the  organ  in  the  right  lateral  posture, 
which  is  the  commoner." 

Garrigues  ^  says : 

"  The  mother's  rectum  causes  a  partial  rotation  of  the  uterus, 
by  which  its  left  edge  is  carried  a  little  more  forward  than  its  right 
edge." 

Parvin^  too  admits  that — 

"  A  slight  rotation  occurs  by  which  the  left  side  is  thrown  toward 
the  front,  and  the  right  side  backward." 

Dr.  G.  Moor  head  reports  a  case  where — 

"  There  was  lateral  rotation  of  the  uterus,  so  that  the  left  ovary 
and  tube  came  into  relation  with  the  anterior  abdominal  wall  just 
external  to  the  middle  of  Poupart's  ligament  on  the  left." 

This  rotation  is  generally  believed  to  be  due  to  the  presence 
of  the  rectum,  which  stretches  from  the  left  sacro-iliac  joint 
obliquely  towards  the  right  side  to  reach  the  mid-line  of  the 
sacrum. 

As  constipation  is  so  universal  with  women,  and  as  the 
rectum  is  the  portion  usually  most  distended,  the  explanation 
is  doubtless  the  correct  one. 

Hart  and  Barbour'^  say: 

"  Rectal  distension  displaces  the  uterus  forwards  and  to  the 
right  side." 

The  variations  in  position  of  the  uterus  due  to  distension 
of  the  bladder  are  more  evanescent ;  the  pressure  comes  to  be 
directed  on  to  the  anterior  surface  of  the  uterus  in  a  direction 
backwards  and  upwards. 

Apart  from  the  oblique  twist  of  the  uterus,  the  whole 

1  Spiegelberg,  "  A  Text-book  of  Midwifery."  New  Sydenham  Society 
Translation,  1887,  p.  32. 

2  Garrigues,  "  Science  and  Art  of  Obstetrics,"  1902,  p.  83. 

^  Parvin,  "  The  Science  and  Art  of  Obstetrics,"  3rd  ed.  1897,  p.  71. 
*  Hart  and  Barbour,  "  Manual  of  Gynecology,"  5th  ed.  1897,  p.  52. 


8 


THE  CAUSATION  OF  SEX 


organ  lies  far  more  commonly  to  the  right  of  the  mid-hne  of 
the  body  than  to  the  left. 
Thus  Garrigues^  says: 

"  The  fundus  uteri  lies  a  little  nearer  to  the  right  side  than  to  the 
left"; 

while  Cunningham^  writes : 

"  The  uterus  rarely  lies  exactly  in  the  mesial  plane  of  the  body, 
but  usually  bends  to  one  or  other  side,  most  frequently  towards 
the  right"; 


Fig.  3. — The  Relation  between  the  Pelvis  and  the  Pelvic 
Organs  and  the  Surface  of  the  Body.  (Modified  from  Norris 
and  Dickinson.) 

It  shows  the  uterus  pushed  by  the  rectum  over  towards  the  right  side;  the  right  Fallopian  tube, 
F.T.R.,  is  thus  carried  backwards.  The  ovaries  are  shown  more  or  less  encircled  by  their 
respective  tubes;  the  right  ovary  is  larger  than  the  left. 


1  Garrigues,  "  Diseases  of  Women."  3rd  ed.  1900,  p.  54. 

2  Cunningham,  "  Text-book  of  Anatomy,"  1903,  p.  11 32. 


ANATOMY  OF  FEMALE  GENERATIVE  ORGANS  9 

and  Gerrish^  says: 

"  As  a  rule,  the  uterus  does  not  occupy  the  median  line  of  the  body, 
but  is  somewhat  deflected,  usually  to  the  right.  There  is  also  present 
a  certain  amount  of  torsion,  by  means  of  which  the  left  superior 
angle  is  carried  a  little  farther  forward  than  the  right." 

The  cavity  of  the  body  of  the  uterus,  when  seen  from  the 
front,  is  triangular  in  shape,  and,  Hke  the  whole  organ,  varies 
in  its  measurements ;  thus  Richet^  gives  the  following  figures : 


Virgin 
Utei  us. 

Multiparous 
Uterus. 

I 'So  in. 

2-44  in. 

o-6o  in. 

1-24  in. 

Vertical  diameter  of  cavity 
Transverse  diameter  of  cavity 

The  cavity  of  the  cervix  is  spindle-shaped,  with  narrowed 
openings  above  into  the  body  of  the  uterus,  the  internal  os, 
and  below  into  the  top  of  the  vagina,  the  external  os,  or 
mouth  of  the  womb. 

It  should  be  borne  in  mind  that,  though  usually  described 
separately,  the  cavity  of  the  cervix  uteri  and  the  cavity  of 
the  body  are  really  continuous,  and  practically  form  a  single 
cavity  only,  which  should  normally  in  the  woman's  erect 
posture,  and  when  seen  from  the  side,  show  a  slight  curve, 
whose  concavity  looks  forwards  and  downwards. 

The  cavity  of  the  body  of  the  uterus  is  lined  by  mucous 
membrane,  which  undergoes  monthly  growth,  and  some 
superficial  decay.  The  glands  in  this  membrane,  the  uterine 
glands,  secrete  a  thin  secretion  which  serves  to  keep  the 
uterine  cavity  moist. 

The  walls  of  the  cavity  of  the  uterus,  even  in  a  virgin,  are 
not  in  complete  apposition,  being  always  separated  by  a 
certain  quantity  of  this  mucus,  and  thus  the  cavity  is 
always  dilatable. 

In  the  event  of  a  woman  bearing  a  child  the  virgin  shape 
and  size  of  the  cavity  of  the  uterus  is  lost,  and  is  never 
regained. 

Into  the  cornu,  or  upper  angles  of  the  cavity  of  the  body, 
the  Fallopian  tubes  open ;  by  its  lower  opening,  the  internal 
OS,  the  uterine  cavity  communicates  via  the  cervix  with 
the  vagina  or  external  genital  passage. 

^  Gerrish,  "  Text-book  of  Anatomy,"  2nd  ed.  1903,  p.  858. 
2  Richet,  quoted  by  Hart  and  Barbour,  op.  cit.,  p.  16. 


10 


THE  CAUSATION  OF  SEX 


In  various  abnormal  uteri  we  find  the  cavity  of  the  uterus 
consisting  of  two  parts,  and  making  with  the  cavity  of  the 
cervix  a  Y-shaped  cavity;  in  other  cases  the  uterus  and 
cervix  are  completely  doubled. 

The  origin  of  these  malformations  is  easily  explained,  as 
the  normal  uterus  is  originally  formed  by  the  fusion  of 
two  parallel  tubes,  the  so-called  Miiller's  ducts;  hence  if 
the  septum  between  them,  due  to  their  coalescence,  is  not 


DIVIDED 


UTERUS  BICORNIS 
2C0RNU  1  CERVIX 
1  VAGINA 


DOUBU 

UTERUS,  CERVIX 
&  VAGINA 


UTERUS 

SUBSEpruS 


Fig.  4. — Various  Abnormal  Human  Uteri.      (Modified  from  Kehrer.) 
U.C.  Uterine  Comu  and  Cavity,     C.  Cervix  of  Uterus.    V.  Vagina. 

absorbed,  the  cavity  comes  to  be  divided  more  or  less 
completely  into  two. 

When  the  cavity  is  thus  divided  above,  but  coalesced 
below,  and  thus  opens  into  a  single  vagina,  as  in  the  uterus 
bicornis  or  two-horned  uterus,  the  human  uterus  closely 
resembles  in  form  the  uterus  of  the  mammalia  as  a  class. 

The  function  of  the  uterus  is  to  receive  the  ovum,  especially 
when  fertilised,  to  retain  and  support  it  during  its  growth 
and  development  into  the  foetus,  and  then  to  expel  it  when 
able  to  maintain  a  separate  external  existence. 


ANATOMY  OF  FEMALE  (xENERATIVE  ORCrANS     ii 

The  Fallopian  Tubes. — The  Fallopian  tubes  or  oviducts 
are  two  in  number — a  right  and  a  left;  the}^  are  curving 
muscular  canals,  arising  one  from  each  side  of  the  fundus  of 
the  uterus  at  its  cornu  or  upper  angle.  They  run  outwards 
laterally  from  the  uterus  to  the  ovaries,  and  each  ends  by  a 
fringed  and  funnel-shaped  expanded  opening,  the  abdominal 
ostium,  close  to  and  in  immediate  proximity  to  its  respective 
right  or  left  ovary.  Each  tube  is  lined  internally  by  mucous 
membrane  covered  by  special  epithelium,  which  has  a  wave- 
like action  towards  the  uterine  cavity,  due  to  cilia  or  fine 
hair-like  processes  which  project  into  the  lumen  of  the  tube; 
their  movement  being  always  in  one  direction  impels  on- 
wards to  the  uterus  any  ovum  which  may  enter  them. 

A  small  quantity  of  thin  albuminous  fluid  is  secreted  by 
the  mucous  membrane. 

The  inner  or  uterine  third  of  each  tube  is  straighter  and 
thinner  than  the  outer  two-thirds,  which,  increasing  gradu- 
ally in  size,  curves  sickle-like  to  encircle  its  corresponding 
ovary  for  more  than  half  of  its  circumference. 

The  tubes  are  dilatable;  the  lumen  varies  in  size,  being 
least  where  they  open  into  the  uterine  cavity,  and  greatest 
as  they  approach  their  expanded,  outer,  or  abdominal  open- 
ing, near  to  the  ovary. 

The  average  length  of  each  tube  is  four  inches,  but  they 
are  rarely  of  equal  size  or  length. 

Thus  Hart^  says: 

"  The  right  Fallopian  tube  is  usually  larger  than  the  left," 
while  Montgomery'^  says: 

"  The  Fallopian  tubes  vary  in  size  and  length,  the  right  tube 
being  the  longer." 

The  tubes  have  a  considerable  range  of  mobility,  and  are 
easily  displaced  by  tumour  growth  or  inflammatory  affec- 
tions ;  the  tubes  are  relatively  very  much  larger,  in  compari- 
son to  the  size  of  the  human  uterus,  than  are  the  Fallopian 
tubes  in  most  of  the  mammalia — so  much  so  that  the 
mammalian  Fallopian  tube  is  generally  overlooked,  and  the 
uterine  cornu  or  branches  are  thought  to  be  the  tubes. 

1  Hart,  "  Atlas  of  Female  Pelvic  Anatomy,"  1884.  p.  12. 
-  Montgomery,  "  Practical  Gjmaecology, "  1900,  p.  132. 


12  THE  CAUSATION  OF  SEX 

The  function  of  the  tubes,  as  their  name  oviduct  implies, 
is  to  convey  the  ovum,  fertiHsed  or  not,  into  the  uterine 
cavity.  They  are  practically  the  excretory  ducts  of  the 
ovaries,  but,  unlike  most  other  excretory  ducts,  they  are 
not  part  of  the  gland  whose  product  they  transmit,  but 
are  portions  of  the  receiving  organ. 

The  contractions  of  the  muscular  layers  of  the  tubal 
wall  help  in  the  propulsion  of  the  ovum,  and  its  easy  progress 
is  assisted  by  the  thin  layer  of  albuminous  fluid  moistening 
the  tubal  lumen. 

The  Ovaries. — The  ovaries  or  genital  glands  are  the 
essential  organs  of  reproduction;  they  dominate  the  entire 
reproductive  life  of  the  woman. 

They  are  two  in  number,  a  right  and  left,  and  lie  on  the 
right  and  left  sides  respectively  of  the  uterus.  Each  ovary 
is  a  solid,  oval,  or  almond-shaped  organ,  and  is  more  or  less 
encircled  by  the  outer  or  abdominal  end  of  its  corresponding 
Fallopian  tube. 

The  ovaries  vary  in  size  considerably  in  different  women, 
and  also  at  different  times  in  the  same  woman,  according  to 
the  condition  of  their  functional  activity.  Thus  each  ovary 
enlarges  when  about  to  discharge  an  ovum,  so  that  T.  G. 
Stevens'^  says: 

"  The  ripe  Graafian  follicle  may  measure  an  inch  in  diameter, 
and  as  it  projects  from  the  surface  its  general  effect  may  be  to 
almost  double  the  size  of  the  ovary  "  ; 

while  Garrigties^  says: 

"  The  ovaries,  or  at  least  one  of  them,  swell  regularly  before  each 
menstrual  period,  and  decrease  after  menstruation  "  ; 

an  ovary  also  enlarges  markedly  when,  having  discharged 
an  ovum  which  becomes  fertilised,  a  true  corpus  luteum  of 
pregnancy  is  formed  in  the  substance  of  the  ovary. 
The  two  ovaries  are  not  of  equal  size,  the  right 

BEING  LARGER  THAN  THE  LEFT  OVARY.      H.  Morris^  says: 
"  The  right  ovary  is  usually  a  little  larger  than  the  left." 

1  Stevens,  "  Diseases  of  Women,"  1912,  p.  25. 

2  Garrigues,  "  Diseases  of  Women,"  1900,  p.  596. 

3  Henry  Morris,  "  A  Treatise  on  Human  Anatomy,"  2nded.  1898,  p.  1052. 


ANATOMY  OF  FEMALE  GENERATIVE  ORGANS  13 

An  average  ovary  measures  ij  in.  long  by  f  in.,  and  |in. 
thick. 

Each  ovary  is  attached  by  its  anterior  border  to  the 
posterior  surface  of  the  broad  Hgament,  and  to  the  uterus 


O 


O    0 

Is  < 
w 


by  a  muscular  band  of  varying  length,  averaging  one  inch, 
the  ovarian  or  utero-ovarian  ligament ;  also  by  an  enlarged 
tubal  fringe  to  the  open  or  abdominal  fringed  end  of  the 
Fallopian  tube. 

The  relative  position  of  the  ovaries  in  the  body  is  much 


14  THE  CAUSATION  OF  SEX 

disturbed  by  pregnancy,  as  also  by  the  growth  in  them  or 
near  them  of  any  tumour. 

At  birth  the  ovaries  are  much  longer  than  their  width, 
so  that  they  are  described  as  cucumber-shaped;  prior  to 
puberty  and  ovulation  they  resemble  smooth  olives,  while 
in  the  adult  who  has  ovulated  and  menstruated  for  years 
the  ovary  becomes  scarred  and  wrinkled,  so  that  it  more 
closely  resembles  a  peach-stone. 

The  substance  of  each  ovary  consists  of  a  groundwork  or 
stroma  of  fibrous  and  muscular  tissue,  in  which  run  numerous 
blood-vessels  and  nerves.  It  is  seen  to  be  occupied  by  a  very 
large  number  of  small  vesicles  or  cysts,  called  ovisacs  or 
Graafian  follicles,  after  their  discoverer  Regnerus  de  Graaf. 

Each  Graafian  follicle  or  ovisac  contains  an  ovum  or  eg^, 
floating  in  a  little  clear  albuminous  fluid,  the  Liquor  Folliculi. 

Authorities  differ  in  their  estimates  of  the  number  of 
Graafian  follicles  contained  in  the  two  ovaries  at  the  child's 
birth.     Thus  W.  Williams^  says: 

"  Each  ovary  at  birth  contains  at  least  one  hundred  thousand 
primordial  ova," 

while  Piersol^  puts  them  much  lower.     He  says: 

"  The  entire  number  contained  within  the  two  ovaries  of  the 
child  being  estimated  at  over  seventy  thousand." 

All  such  figures,  however,  as  Dr.  T.  G.  Stevens'"^  definitely 
states, 

"  must  be  viewed  with  some  scepticism,  because  the  enumeration 
of  the  Graafian  follicles  in  an  ovary  cannot  be  a  matter  of  any 
certainty,  and  there  must  be  a  large  margin  for  errors  of  observation." 

What,  however,  is  certain  is,  that  by  far  the  larger  pro- 
portion of  the  Graafian  follicles  atrophy  and  disappear,  but 
do  not  burst,  so  that  by  the  time  of  puberty  the  number  of 
Graafian  follicles  remaining  in  the  two  ovaries,  and  thus 
capable  of  development,  is  only  about  one-third  of  those 
present  at  birth. 

1  Whitridge  Williams,  "  Obstetrics,"  1903,  p.  61. 

2  Piersol,  in  Norris  and  Dickinson's  "  Text-book  of  Obstetrics,"  p.  61. 

^  Stevens,  "  Trans.  Obstet.  Soc,"  vol.  xlv.,  1903,  p.  465.  "  The  Fate 
of  the  Ovum  and  Graafian  Follicle  in  Pre- menstrual  Life." 


ANATOMY  OF  FEMALE  GENERATIVE  ORGANS     15 

The  Graafian  follicles  are  scattered  throughout  the  super- 
ficial or  greater  part  of  the  substance  of  both  ovaries.     The 


Fig.  6. — Section  of  an  Ovary  from  a  Woman  on  the  First  Day 
OF  Menstruation,  showing  Burst  Follicle  opening  on  the 
Surface  ;  other  Follicles  in  Different  Stages  of  Development. 
(Modified  from  Leopold.) 

deeper  part  of  the  ovary  contains  loose  connective  tissue 
and  muscle  fibres,  and  transmits  the  blood-vessels  and 
nerves. 


TP 

Fig.  7. — Diagram  of  a  Graafian  F'ollicle  shortly  before  its 
Rupture.     (Much  magnified.) 

S.E.  Surface  Epithelium  of  Ovary,  showing  at  B  thinning  where  the  follicle  is  about  to  rupture 
and  discharge  the  Ovum,  OV.  G.F.  The  Graafian  Follicle,  filled  with  the  liquor  folliculi, 
in  which  is  OV.,  the  Ovum,  filled  by  the  granular-looking  vitellus  or  yolk;  in  this  lies 
N.,  the  Ovum  Nucleus  or  germinal  vesicle;  this  contains  a  nucleolus  or  germinal  spot. 
S.O.  The  substance  or  Stroma  of  the  Ovary.  T.F.  Condensed  ovarian  stroma,  forming  the 
external  wall  or  Tunica  Fibrosa  of  the  follicle.  T.P.  The  Tunica  Propria  or  true  wall  of  the 
follicle,  lined  internally  by  layers  of  cells,  M.G.,  the  Membrana  Granulosa,  which  are  heaped 
around  the  Ovum  to  form  D.P.,  the  discus  proligerus.  Z.P.  The  Zona  Pellucida,  the  outer 
wall  of  the  Ovum.    OV.  The  Ovum;  should  be  more  circular  than  it  is  drawn. 


i6  THE  CAUSATION  OF  SEX 

Every  follicle  contains  an  ovum,  now  often  called  an 
oocyte,  each  ovum  contains  a  germinal  vesicle  or  nucleus, 
and  this  germinal  nucleus  contains  a  germinal  spot  or 
nucleolus. 

Occasionally  the  Graafian  follicle  contains  two  ova 
instead  of  the  more  usual  one  (see  K,  Fig.  8).     Heisler^  says: 

"  As  a  rule  each  Graafian  foUicle  or  ovisac  contains  but  one  ovum, 
though  sometimes  two,  and  more  rarely  three  are  present." 

Or  the  single  ovum  may  contain  a  double  nucleus — i.e.,  two 
germinal  vesicles  instead  of  the  more  frequent  single  one 
(see  H,  Fig.  8). 

1  Heisler,  "  Text-book  of  Embryology,"  2nd  ed.  1902,  p.  27 


CHAPTER  II 
PHYSIOLOGY 

Ovulation. — The  chief  function  of  the  ovaries  is  ovulation 
or  the  discharge  of  ripe  ova,  or  oocytes. 

This  is  brought  about  by  the  development  and  maturing 
of  a  Graafian  follicle,  its  rupture,  and  the  discharge  of  the 
by-now-perfected  ovum  which  it  contained.  Normally 
this  occurs  quite  unconsciously  and  without  pain. 

The  enlarging  follicle  having  gradually  approached  the 
ovarian  surface,  its  walls  becoming  .congested,  thinned 
and  weakened,  and  at  one  part  exposed,  it  then  bursts. 
The  liquor  folliculi  is  poured  out,  and  the  ripened  ovum  is 
set  free.     This  is  ovulation  or  the  dehiscence  of  an  ovum. 

Heisler^  says:  ' 

"  Ova  are  extruded  from  the  ovary,  one  or  more  at  a  time,  at 
regular,  generally  monthly,  intervals,  from  puberty  to  the  climacteric, 
usually  during  the  menstrual  period." 

Halliburton  ^  says : 

"  The  ripening  of  an  ovum  occurs  about  once  every  four  weeks." 

In  a  young  girl,  before  the  ovaries  have  begun  to  ovulate, 
i.e.,  to  fulfil  their  physiological  function  of  providing  ova, 
the  surfaces  of  the  ovaries  are  smooth.  Garrigues^  says 
they  are — 

"  even,  smooth,  velvety,  of  pearl-grey  colour.  Later,  each  ovula- 
tion leaving  a  little  puckered  cicatrix,  the  surface  shows  irregular 
depressions." 

Dr.  T.  B.  Grimsdale^  reports  a  case  of  a — 

"  well-developed  girl  aged  22  who  had  never  menstruated."  **  Both 
ovaries  presented  smooth  surfaces  like  that  of  an  olive.  The 
patient  was  a  virgin. ' ' 

^  Heisler,  op.  cit.,  pp.  33,  37. 
^  Halliburton,  "  Physiology,"  191 5,  p.  869. 
^  Garrigues,  op.  cit.,  p.  71. 

*  "  Journal  of  Obstetrics  and  Gynaecology,"  vol.  iii.,  May,  1903.  P-  5oO' 

17  2 


i8 


THE  CAUSATION  OF  SEX 


It  must  be  noted  that  the  greater  proportion  of  the 
Graafian  foUicles  and  their  contained  ova  are  microscopic, 
hence  an  infinitely  small  piece  ot  an  ovary  may  contain 
immature  Graafian  follicles  which  are  capable  of  develop- 
ment and  maturation.  It  is  only  as  the  growing  follicles 
approach  the  free  surface  of  the  ovary,  preparatory  to 
bursting,  that  they  become  visible  to  the  naked  eye. 


Fig.  8. — Composite  Diagram  of  a  Magnified  Section  of  an 
Ovulating  Ovary. 

A.  Ripe  ovum  just  shed  from  the  ruptured  Graafian  Follicle,  with  cells  of  the  D.P.  or  Discus 
Proligerus  still  clinging  to  it.  G.F.  A  Graafian  Follicle,  OV.  An  Ovum.  N.  The  nucleus 
of  an  ovum.  L.F.  The  Liquor  Folliculi  or  liquid  contents  of  a  follicle.  S.  The  fibro- 
muscular  stroma  or  groundwork  of  the  Ovary.  B.V.  Blood-vessels.  E.  Small  Graafian 
Follicles  near  the  surface  of  the  Ovary.  C.  Epithelium  covering  the  free  surface  of  the  Ovary. 
T.  Typical  G.F.  containing  the  normal  single  ovum  with  one  nucleus.  H.  An  ovum  which 
has  two  nuclei.  K.  Two  distinct  ova  in  a  G.F.;  each  is  surrounded  by  cells  of  the  D.P. 
M.G.  Cells  lining  the  walls  of  the  follicles,  and  known  as  the  Membrana  Granulosa. 


The  Graafian  folHcle  having  ruptured  and  the  ovum 
escaped,  the  rent  in  the  substance  of  the  ovary  then  begins 
to  heal  and  the  cavity  of  the  old  follicle  or  ovisac  fills  up, 


PHYSIOLOGY  19 

being  partly  obliterated  by  the  collapse  and  contraction 
of  the  sac  wall,  while  the  remainder  of  the  cavity  is  filled 
with  blood  incidental  to  the  rupture. 

The  Corpus  Luteum. — Subsequent  changes  in  the 
filled-up  follicle  convert  it  into  a  yellow-coloured  body  called 
the  corpus  luteum.  The  after-history  of  the  corpus  luteum 
is  entirely  dependent  on  whether  the  ovum  which  was  set 
free  from  the  Graafian  follicle  becomes  fertilised  or  not. 

If  not  fertilised  the  site  of  the  follicle  is  gradually  obliter- 
ated, so  that  after  about  two  months,  only  a  depressed 
cicatrix,  or  pit,  shows  on  the  surface  of  the  ovary  from 
whence    the   ovum   was   discharged;    this   smaller   corpus 


Fig.  9. — Vertical  Section  of  a  Woman's  Ovary  a  few  Days  after  a 
Menstrual  Period,  showing  the  Corpus  Luteum,  and  some 
Graafian  Follicles.     (Modified  from  Leopold.) 

Note  their  relative  sizes,  and  the  folded  cell-wall  of  the  corpus  luteum. 

luteum,  which  thus  follows  menstruation  only,  is  known 
as  a  false  corpus  luteum  or  corpus  luteum  of  menstruation. 
Play f air ^  says: 

"  The  tissue  of  the  ovary  at  the  site  of  laceration  also  shrinks, 
and  this,  aided  by  the  contraction  of  the  follicle,  gives  rise  to  one 
of  those  permanent  pits  or  depressions  which  mark  the  surface  of 
the  adult  ovary." 

If  the  discharged  ovum  be  fertilised  we  get  pregnancy, 
and  the  so-called  true  corpus  luteum  or  corpus  luteum  of 
pregnancy  forms. 

This  true  corpus  luteum  continues  to  grow  for  from  three 
to  four  months,  so  that  it  comes  to  be  a  very  much  enlarged 
edition  of  the  other  or  menstrual  form  of  corpus  luteum.  At 
the  end  of  pregnancy  it  is  very  evident  on  section  of  the 
ovary,  while  often  it  may  be  seen  to  be  present  even  without 
opening  the  ovary.     Its  entire  obliteration,  and  termination 

1  Playfair,  op.  cit.,  p.  67. 


20  THE  CAUSATION  OF  SEX 

as  a  depressed  scar  on  the  ovarian  surface,  does  not  take 
place  for  two  months  after  deUvery.  The  differences 
between  the  corpus  luteum  after  menstruation — i.e.  when 
the  ovum  was  not  fertihsed — and  the  corpus  luteum  when 
fertilisation  has  occurred  are  differences  of  degree  only,  as 
Piersol^  says: 

"  the  stimuhis  of  impregnation  leading  usually  to  excessive  de- 
velopment." 


This  is  also  thus  confirmed  by  Whitridge  Williams 


2. 


"  Both  the  true  and  the  false  corpora  lutea  present  exactly  the 
same  structure,  the  larger  size  of  the  so-called  true  corpus  luteum 
being  simply  due  to  the  increased  vascular  supply  incident  to 
pregnancy." 

Without  an  operation  or  post-mortem,  enabhng  us  to  see 
which  ovary  contains  the  corpus  luteum,  we  are  quite 
vinable  to  say  from  which  ovary  the  ovum  was  derived;  so 
that,  as  Hirst^  says: 

' '  The  true  corpus  luteum  is  of  value  as  an  indication  of  the  ovary 
from  which  the  impregnated  ovum  came." 

We  consequently  see  that  a  corpus  luteum  signifies  a 
previous  ovulation. 

Puberty. — Puberty  is  the  epoch  in  a  female's  life  which 
marks  the  change  from  childhood  to  womanhood;  it  is  the 
beginning  of  her  fruitful  period.  It  is  a  gradual  develop- 
ment, and  usually  takes  place  from  the  fourteenth  to  the 
fifteenth  year  of  a  girl's  age. 

Spiegelberg'^  says: 

"  The  ovaries  and  the  ova  contained  in  them  are  the  first  to 
arrive  at  maturity."  "  The  arrival  at  puberty,  however,  is  generally 
not  coincident  with  the  complete  development  of  all  the  generative 
organs,  and  especially  not  of  the  uterus;  the  latter  continues  to 
grow  considerably  up  to  the  twentieth  year." 

For  the  first  twelve  years  of  a  girl's  life  the  uterus  usually 
retains  its  infantile  condition,  but  at  puberty  it  rapidly 

1  Piersol  in  Norris  and  Dickinson,  "  Text-book  of  ObstetricB, "  1897,  p.  61 , 

2  VV.  Williams,  "  Obstetrics,"  1903,  p.  71. 

^  Hirst,  "  Text-book  of  Obstetrics,"  2nd  ed.  1900,  p.  63. 
*  Spiegelberg,  op.  cit.,  pp.  59  and  62. 


PHYSIOLOGY  21 

begins  to  increase  in  size.     There  are,  too,  certain  external 
signs  of  the  approach  of  womanhood,  for  the  breasts  become 
larger  and  menstruation  begins. 
As  Bland'Suttofi^  says : 

"  In  the  female  puberty  is  strikingly  declared  by  the  institution 
of  menstruation,"  so  that  "the  actual  establishment  of  puberty  is 
reckoned  from  the  first  menstruation." 

Further,  he  says^: 

"  With  tlic  onset  of  puberty  the  ovaries,  previously  small,  en- 
large and  exhibit  the  periodic  series  of  changes  known  as  ovulation." 

Hence  we  get  the  two  processes,  ovulation  and  menstrua- 
tion, normally  starting  together  at  puberty;  and  being 
coincident  at  their  beginning,  they  usually  remain  so  during 
life.  It  is  not,  therefore,  until  the  approach  of  puberty  that 
the  regular  full  development  of  the  (rraafian  follicles  and 
their  contained  ova  begins  to  take  place;  a  few  partially 
develop  and  then  abort,  and  a  very  minute  proportion  may 
even  burst  and  discharge  an  ovum  before  puberty,  proof 
being  that  girls  sometimes  get  pregnant  before  they  first 
menstruate;  but,  as  PiersoP  says: 

**  The  advent  of  puberty  marks  the  establishment  of  the  full  and 
regular  development  of  the  Graafian  follicles  and  their  contained 
ova,  accompanied  by  the  usual  attendant  phenomena  of  men- 
struation." 

Herman  "*  says : 

"  Graafian  follicles  ripen,  though  they  have  not  yet  been  proved  to 
burst,  long  before  menstruation  has  appeared;  and  there  is  reason 
to  think  that  they  may  degenerate  without  bursting  before  puberty  " ; 

and   W.   Williams,^  while   admitting  their  growth  during 
childhood,  says: 

"  They  rarely  rupture  at  this  time,  on  account  of  their  position 
in  the  depths  of  the  ovary  and  the  intervention  of  a  thick  layer  of 
cortex  between  them  and  the  surface." 

1  Bland-Sutton,  "  Diseases  of  Ovaries,"  2nd  ed.  1896,  p.  5. 

2  Bland-Sutton  and  Giles,  "  Diseases  of  Women,"  4th  ed.  1904,  p.  17. 

3  Piersol,  op.cit.,p.yi. 

*  Herman,  "  Diseases  of  Women,"  2nd  ed.  1903,  p.  518. 
5  W.  Williams,  op.  ciL,  p.  66. 


22  THE  CAUSATION  OF  SEX 

T.  G.  Stevens'^  says: 

"  No  rupture  of  the  follicles  takes  place,  and  nothing  in  the 
least  approaching  the  structure  of  a  corpus  luteum  is  formed  in 
pre-menstrual  life." 

So  that  we  see  that  rupture  of  the  follicles  and  the  forma- 
tion of  corpora  lutea  do  not  normally  occur  prior  to  the 
onset  of  menstruation. 

Menstruation. — Menstruation  is  the  expulsion  of  the 
menses,  a  periodic  discharge  of  a  bloody  fluid  containing 
mucus  and  debris  derived  from  the  superficial  cells  of  the 
mucous  membrane  lining  the  cavity  of  the  uterus.  Normally 
it  recurs  every  twenty -eight  days  throughout  the  repro- 
ductive period  of  a  woman's  life. 

It  begins  at  puberty  and  ceases  at  the  "  change  of  life  " 
or  menopause,  and  on  an  average  it  may  be  taken  to  extend 
from  the  fourteenth  to  the  forty-fifth  year  of  a  woman's 
life,  so  that  the  average  duration  of  the  menstrual  function 
is  about  thirty  years. 

Exceptions  to  this  age-limit  at  both  the  beginning  and 
the  cessation  are  frequent,  several  cases  of  precocious 
menstruation,  some  in  infants  shortly  after  birth  even, 
being  recorded.  These  very  early  cases  are  open  to  the 
objections  that  bloody  vaginal  discharge  is  not  necessarily 
menstruation,  and  that  in  most  cases  it  does  not  recur  and 
so  is  not  periodic,  as  in  the  case  recorded  by  Dr.  R.  Jardine 
in  the  "British  Medical  Journal,"  February  1901;  and 
Dr.  Jellett  is  doubtless  correct  when  he  says,  in  "  Journal 
of  Obstetrics  and  Gynaecology,"  vol.  i.  1902,  p.  700: 

"  Menstruation  appeared  to  him  to  be  a  misnomer  for  the  red 
discharge  that  occurred  in  newly  born  female  children.  It  was 
an  isolated  haemorrhage,  not  a  menstrual  flow." 

Dr.  Macnaughton-Jones,^  however,  tjuotes  a  case  by 
Mengus  of  regular  menstruation  in  a  child  23  months  old. 

It  is  commoner  to  find  cases  of  delayed  menopause,  some 
women  continuing  to  menstruate  beyond  the  age  of  sixty. 
Dr.  E.  J.  Tilt^  met  with  two  cases  at  the  6ist  year  out  of 

^  hoc.  cit.,  p.  468. 

^  Macnaughton-Jones,  "  Diseases  of  Women,"  1900,  p.  30. 

3  Tilt,  "  Diseases  of  Women,"  1853,  p.  44. 


PHYSIOLOGY  23 

284  patients ;  while  W.  Williams^  quotes  a  case  of  a  woman 
who  had  her  22nd  child  at  the  age  of  63  years,  "  after  which 
she  still  continued  to  menstruate." 

It  is  usually  said  that  menstruation  is  arrested  during 
pregnancy  and  during  lactation :  this  arrest  is  not  absolutely 
certain,  for  menstruation  may  continue  for  the  first  two 
or  three  months  of  pregnancy.  It  very  rarely,  if  ever, 
does  so  for  longer  in  a  normal  uterus;  but  for  men- 
struation to  take  place  during  lactation  is  far  more 
common. 

Remfry^  states  that  among  900  suckhng  women,  in 
57  per  cent,  only  was  menstruation  entirely  absent,  and 
that  43  per  cent,  of  suckling  women  menstruate  more 
or  less,  26  per  cent,  of  these  menstruating  with  absolute 
regularity. 

Karl  Heil,^  as  a  result  of  his  own  observations  of  200 
women,  found  that  125  of  them  menstruated  during  lacta- 
tion— that  is,  62  5  per  cent. — and  adding  his  figures  to 
those  of  other  authors,  concludes  that  about  one-half  of 
all  women  menstruate  during  lactation.  Also  that  as  the 
number  of  pregnancies  increases,  the  liability  to  menstruate 
during  lactation  increases  also. 

He  considers  it  probable  that  the  women  who  menstruate 
during  lactation  represent  the  normal  type,  rather  than 
those  who  have  amenorrhoea. 

Menstruation  is  the  outward  periodic  sign  that  the  lining 
or  mucous  membrane — the  endometrium — of  the  uterine 
cavity  had  been  prepared  to  receive  and  give  anchorage 
to  a  fertilised  ovum;  hence  Geddes  and  Thomson"^  say  that 
"  menstruation  is  comparable  to  an  abortion  prior  to  a  new 
ovulation";  but  as  the  stimulus  imparted  by  a  fertilised 
ovum  is  not  forthcoming,  its  degeneration  and  discharge 
accompanied  by  some  bleeding  follow. 

Menstruation  is  therefore,  as  Dr.  John  Power  in  1821 
wrote  of  it,  a  "  disappointed  pregnancy  ";  or,  as  Dr.  Robert 
Cory  ^  calls  it,  "  only  the  abortion  of  an  unimpregnated  ovum 

1  W.  Williams,  op.  cit.,  p.  74. 

2  Remfry,  "  Trans.  Obstet.  Soc,"  vol.  xxxviii.  1896,  p.  26. 

3  "  Monat.  fiir  Geb.  und  Gyn." 

*  Geddes  and  Thomson,  "  The  Evolution  of  Sex,"  1901,  p.  265. 
^  Dr.  R.  Cory,  "  Lancet,"  November  7,  1891. 


24  THE  CAUSATION  OF  SEX 

or  egg  ";  while  Dr.  Peter  Horrocks^  terms  it  a  "  miniature 
parturition." 

Dr.  A.  W.  A ddinselP  ssiys: 

"  Menstruation  may  be  considered  as  evidence  of  a  failure  of 
these  anticipations  " — "  for  the  implantation  of  an  impregnated 
ovum." 

The  process  of  building  up  a  fresh  nidus  of  swollen  mucous 
membrane,  to  prepare  for  an  oosperm  or  fertilised  ovum, 
recurs  after  each  discharge  of  the  preceding  unused  one; 
the  degeneration  an^  discharge  of  some  of  the  hypertrophied 
mucous  membrane  is  the  result  of  disappointment  in  the 
absence  of  an  oosperm.  This  constitutes  menstruation; 
and  the  process  is  made  evident  to  the  woman  by  a  varying 
amount  of  pain  and  constitutional  disturbance,  and  clinically 
by  variations  in  temperature,  pulse,  blood  pressure,  etc. 

These,  then,  are  the  phenomena  of  menstruation,  and  have 
nothing  whatever  to  do  with  its  causation. 

Some  few  authorities,  as  Heape  and  F.  H.  Marshall,  are 
disposed  to  call  menstruation  a  preparation  for  pregnancy, 
not  an  undoing  of  the  preparations:  which  is  correct  is 
immaterial  to  this  theory  of  sex  causation,  but  certainly,  if 
this  is  so,  pregnancy  in  a  non-menstruating  woman,  i.e.  in 
a  woman  whose  uterus  was  not  prepared  for  pregnancy, 
would  be  very  difficult  to  explain. 

Proof  that  the  presence  of  menstruation  is  not  necessary 
in  order  that  impregnation  should  occur  is  shown  by  the 
cases  of  pregnancy  beginning  during  long  periods  of  amenor- 
rhoea;  thus — 

Strassmann^  recorded  a  remarkable  case  of  absence  of 
menstrual  periods  and  repeated  pregnancies.  A  woman  of 
45  began  to  menstruate  at  i6  years  of  age,  and  continued 
regularly  up  to  her  i8th  year,  when  she  had  her  first  child. 
From  the  i8th  to  the  39th  year  she  did  not  menstruate 
at  all,  but  had  seventeen  full-time  pregnancies  and  a  three- 
months'  miscarriage.  At  the  age  of  39  menstruation 
returned  and  continued  regularly  monthly  until  she  was  45. 

So  that  for  over  twenty  years  her  uterus  was  not  prepared 

1  Horrocks,  "  Trans.  Obstet.  Soc,"  vol.  xl.  1898,  p.  173. 

2  Dr.  A.  W.  Addinsell,  "  Lancet,"  March,  1905,  p.  791. 
^  "  Lancet,"  July,  1905,  p.  171. 


PHYSIOLOGY  25 

by  menstruating  for  pregnancy  !  yet  she  became  pregnant  ! 
and  gave  birth  to  seventeen  children. 

A  somewhat  similar  case  occurred  in  my  own  practice : 

Mrs.  W.  A.  T.  was  aged  38  in  September  191 1.  Her 
menstrual  periods  began  when  she  was  between  16  and  17 
years  of  age,  irregularly  at  first  and  always  rather  scanty. 

She  had  three  children  in  the  first  three  years  of  her 
married  life.  After  that  her  periods  only  occurred  at  very 
long  intervals,  never  less  than  a  year  apart. 

In  September  1911,  being  then  pregnant  some  three 
months,  she  engaged  me  to  attend  her  in  her  confinement. 
She  had  then  just  gone  two  years  and  six  months  since 
her  last  period,  and  a  similar  interval  had  elapsed  between 
that  one  and  its  predecessor,  i.e.  two  periods  in  five  years — 
she  had  only  seen  five  periods  altogether  in  the  nine  years 
preceding.  I  delivered  her  on  March  15,  1912,  of  triplets — 
two  girls  and  a  boy;  and  eighteen  months  afterwards  I 
heard  she  had  twin  boys. 

As  in  both  these  cases  menstruation  was  absent  many, 
many  months  prior  to  conception,  it  looks  as  though  the 
contention  that  menstruation  is  a  preparation  for  pregnancy 
cannot  be  maintained — for  presumably  the  uterus  must  be 
"  prepared  for  pregnancy  "  or  pregnancy  could  not  take 
place,  and  in  both  these  cases  no  such  preparation  had  taken 
place,  yet  pregnancy  occurred. 

Unlike  Marshall  and  Heape,  Dr.  T.  G.  Stevens'^  says: 

"  Menstruation  is  much  more  likely  to  represent  the  failure  of 
the  uterus  to  receive  a  fertilised  ovum." 

The  actual  cause  of  menstruation  is  unknown :  it  has  been 
ascribed  to  nerve  influence,  and  is  thought  to  be  probably 
controlled  by  an  undiscovered  nerve  centre  in  the  brain ;  and 
a  sympathetic  nerve  ganglion  in  the  ovary  has  even  been 
described.  True  menstruation  occurs  only  in  women  and 
a  few  (especially  captive)  monkeys;  and  has  therefore  been 
attributed  to  their  erect  postures,  in  most  mammals  the 
amount  of  blood  not  being  sufficient  to  envermeil  the 
discharge. 

It  may  roughly  be  said  that,  normally,  previous  to  the 

1  Dr.  T.  G.  Stevens,  "  Diseases  of  Women,"  p.  64,  1912. 


26  THE  CAUSATION  OF  SEX 

onset  of  menstruation  and  after  its  cessation  (the  meno- 
pause), women  are  incapable  of  bearing  offspring  or  becoming 
pregnant.  This  rule,  however,  like  most  others,  meets  with 
a  few  unimportant  exceptions.  Thus  Dr.  Addinsell^  relates 
a  case  of  pregnancy  in  a  girl  of  13  prior  to  any  appearance 
of  menstruation;  while  of  the  rarer  condition  of  pregnancy 
after  the  menopause,  the  following  is  a  case  from  my  own 
private  practice:  Early  in  March  1904  I  attended  Miss  E.  C, 
aged  50.  She  had  passed  "  the  change,"  and  had  seen 
nothing  for  just  two  years.  Meeting  her  former  lover 
once  again  after  many  years'  absence,  and,  deeming  herself 
safe  from  the  possibility  of  pregnancy,  she  ran  the  risk, 
and  was  duly  delivered  by  me  of  a  living  healthy  male 
illegitimate  child,  nearly  three  years  after  having  ceased 
to  menstruate.     Menstruation  did  not  reappear. 

A  somewhat  similar  case  is  recorded  by  Dr.  R.  Hann^ 
in  a  woman  of  49  years,  who  gave  birth  to  her  thirteenth 
child — a  boy — three  years  after  the  menopause;  but  in  this 
case  menstruation  returned  after  weaning  this  child. 

All  authorities  agree  that,  prior  to  puberty,  the  ovaries 
of  a  girl  present  smooth  surfaces;  then,  as  Bland-Sutton^ 
says,  "  from  puberty  to  the  menopause  the  smoothness  of 
the  surface  is  marred  by  scars,  caused  by  the  rupture  of 
mature  follicles  " — that  is,  by  ovulation.  So  that  prior  to 
puberty,  "  strikingly  declared  by  the  institution  of  menstrua- 
tion "  (Bland-Sutton),  ovulation  has  not  occurred  to  scar 
the  smooth  surface  of  the  ovaries. 

The  two  processes,  ovulation  and  menstruation,  evidently 
both  depend  upon  a  common  cause,  possibly  a  periodical 
congestion  induced  and  controlled  by  a  nerve  impulse; 
having  the  same  cause,  they  usually  occur  about  the  same 
time — i.e.  they  are  nearly  if  not  quite  synchronous. 

Heisler"^  says  "  the  two  processes  (ovulation  and  menstrua- 
tion) usually  occur  at  the  same  time  ";  so  that  Temesvary^ 

1  "  Lancet,"  March  25,  1905,  p.  791. 

2  R.  G.  Hann,  "  Journal  of  Obstetrics  and  Gynaecology,"  September 
1902,  p.  290. 

^  Bland-Sutton,  "  Diseases  of  Ovaries,"  1896,  p.  26. 
*  Heisler,  "  Text-book  of  Embryology,"  3rd  ed.  1907,  p.  38. 
5  Temesvary,   "  Journal  of  Obstetrics  and  Gynaecology  of  the  British 
Empire,"  vol.  iii.  1903,  p.  512. 


PHYSIOLOGY  27 

calls  menstruation  "  the  outer  sign  of  ovulation."  Heisler^ 
also  says  '*  the  ovum  is  usually  discharged  from  the  ovary 
during  the  menstrual  period." 

That  ovulation  can  occur  without  menstruation  is  evident 
from  those  rare  cases  where  young  girls  become  pregnant 
before  menstruation  has  begun. 

This  is  chiefly  due  to  the  fact  that  the  ovaries  and  their 
contained  ova  are  fully  developed  earlier  than  the  uterus 
(see  remarks  of  Spiegelberg,  p.  20  ante),  so  that  a  mature 
ovum  may  be  formed  some  time  before  the  uterus  has 
developed  sufficiently  to  menstruate.  The  fertilisation  of 
the  ovum  and  its  consequent  attachment  to  the  wall  of  the 
immature  uterus  cause  the  rapid  and  complete  development 
of  the  uterus,  so  that  the  pregnancy  continues  and  the  child 
is  born  before  its  mother  has  even  menstruated;  but  the 
pregnancy  will  have  caused  the  full  development  of  that 
uterus. 

Ovulation  must  occur  without  menstruation  in  those 
cases  where  women  get  pregnant  during  lactation,  when 
menstruation  is  often  absent. 

There  are  many  reasons  for  believing  that  usually  ovula- 
tion continues  with  its  habitual  regularity  throughout  the 
lactation  period,  the  process  of  lactation  replacing  that  of 
menstruation;  but  for  pregnancy  to  occur  before  the  re- 
appearance of  the  menses  is  not  usual,  Rem  fry  ^  giving  only 
6  per  cent,  as  the  number  of  non-menstruating  women  who 
conceive  during  lactation,  while  60  per  cent,  of  women  get 
pregnant  who  menstruate  during  lactation. 

The  obvious  criticism  of  both  the  above  cases  of  ovulation 
without  menstruation  is  that,  though  both  occasionally 
occur,  yet  both  are  uncommon  and  more  or  less  exceptional ; 
in  both  cases  fertilisation  does  not  usually  occur  till  after 
the  appearance  or  reappearance  of  menstruation. 

That  ovulation  may  occur  and  menstruation  be  absent 
is  most  evident  from  cases  where,  though  the  ovaries  are 
present,  the  uterus  is  either  entirely  absent  or  so  rudimentary 
as  to  be  functionless.  Ovulation  in  this  case  cannot  be 
accompanied  by  its  usual  phenomenon  of  menstruation; 
but  we  must  not  argue  from  congenital  abnormalities. 

1  Heisler,  op.  cit.,  p.  41.  2  Remfry,  loc.  cit. 


28  THE  CAUSATION  OF  SEX 

That  ovulation  usually  occurs  only  at  or  about  the  time 
of  a  menstrual  period,  the  previously  mentioned  exceptions 
notwithstanding,  is  evident  from  the  following  facts. 

After  the  discharge  of  an  ovum  a  corpus  luteum  is  formed ; 
a  corpus  luteum,  therefore,  as  we  have  already  seen,  signifies 
a  previous  ovulation.  The  only  ultimate  trace  of  a  corpus 
luteum  is  a  scar  or  cicatrix  on  the  surface  of  the  ovary. 

If,  therefore,  ovulation  occurred  oftener  than  at  or  about 
the  time  of  a  menstrual  period,  the  signs  of  the  previous 
ovulations,  viz.  scars  of  corpora  lutea,  would  be  increased 
in  number,  and  would  not  correspond  to  the  number  of  men- 
strual periods  experienced,  as  they  practically  invariably  do. 

If  ova  were  habitually  discharged  independently  of 
menstruation — say  one  or  two  ova  every  week,  and  by 
each  ovary — then  at  the  end  of  a  lunar  month  of  four  weeks 
we  ought  to  find  post-mortem  from  eight  to  sixteen  corpora 
lutea  in  the  two  ovaries  for  each  month  or  menstrual  period, 
which  is  absurd.-^ 

W.  Williams^  says: 

"  We  must  conclude  that  ovulation  and  menstruation  usually 
occur  about  the  same  time,  but  that  one  not  infrequently  antedates 
the  other  by  a  few  days." 

The  fact  should  be  pointed  out  that,  if  a  girl  have  men- 
struated only  three  times  in  her  life,  only , three  ovulation  scars 

1  The  statements  made  by  some  operators  that  during  abdominal 
operations  Graafian  follicles  have  been  seen  either  "  just  ruptured,  or 
about  to  rupture,  at  all  periods  of  time  between  two  menstrual  periods  " 
are  fallacious  if  implying  that  this  is  a  normal  condition  of  things. 

These  cases  are  open  to  the  criticism  that  operative  cases  are  mani- 
festly not  normal ;  then,  too,  the  excitement  incident  to  an  approaching 
abdominal  operation,  especially  one  on  the  sexual  organs,  is  quite  sufti- 
cient  to  induce  that  extra  activity,  or  undue  congestion,  which  will  cause 
a  ripening  Graafian  follicle  to  prematurely  rupture. 

It  is  notorious  that  the  menstrual  period  is  often  thus  expedited. 

While  as  to  those  follicles  thought  to  be  "  about  to  rupture  "  we  have 
no  evidence  and  no  data  on  which  to  form  an  opinion  of  the  imminence 
of  rupture  of  a  follicle,  so  that  the  time  of  rupture  of  a  follicle,  deemed 
"  about  to  rupture,"  may  well  be  a  full  week  or  more  distant.  It  is  an 
assumption  to  allege  that  any  follicle  is  "  about  to  rupture  "  if  its  rupture 
within  a  few  hours  is  thereby  meant. 

Numerical  agreement  of  the  number  of  scars  of  corpora  lutea  seen 
with  the  known  number  of  menstrual  periods  experienced  undoubtedly 
show  the  normality  of  their  synchrony. 

2  Williams,  op.  cit.,  p.  77. 


PHYSIOLOGY  29 

will  he  found  in  her  two  ovaries.  If  ovulation  usually  oc- 
curred, say  weekly,  that  girl,  having  seen  three  monthly  or 
menstrual  periods,  should  have  exhibited  in  her  two  ovaries 
not  three  cicatrices  only,  but  from  twelve  to  twenty-four 
at  least,  that  is,  one  each  week  from  each  ovary;  so  that  these 
scars  or  signs  of  ovulation  equal  the  number  of  menstrual 
periods  experienced. 

Strassmann,  quoted  by  Dr.  Macnaughton-Jones,^  says: 

"  Anatomical  examinations  on  the  number  of  corpora  lutea, 
contrasted  with  the  number  of  known  menstruations,  establish  the 
connection  between  ovulation  and  menstruation";  and  "Each 
menstruation  is  the  expression  of  an  ovulation." 

Whether  the  two  processes  strictly  agree  as  to  time  is 
immaterial;  in  fact,  ovulation  probably  usually  precedes 
menstruation  by  a  day  or  two.  Ovulation  is  certainly 
usually  a  painless  and  spontaneous  process,  which  we  are 
quite  unable  to  induce,  though  sexual  excitement  probably 
helps  to  do  so. 

Ovulation  is  the  function  of  the  ovaries,  the  period  of 
functional  activity  of  the  ovaries  is  coincident  with  the 
woman's  menstrual  life;  so  that  both  ovulation  and  men- 
struation occur  only  during  the  period  of  a  woman's  potential 
fertility. 

That  menstruation  and  ovulation  are  dependent  on  a 
common  cause  is  evident  from  the  facts  that — 

What  stops  ovulation  also  stops  menstruation:  in  the 
complete  congenital  absence  of  the  ovaries,  though  the 
uterus  be  present,  menstruation  does  not  occur. 

When  the  ovaries  atrophy  in  old  age,  menstruation 
stops. 

When,  as  is  normal  prior  to  puberty,  the  ovaries  are  not 
active  and  ovulating,  menstruation  does  not  occur,  so  that 
when  ovulation  begins  menstruation  also  usually  begins. 

Alban  Dor  an  ^  has  pointed  out  that  among  the  Esquimaux, 
during  the  Arctic  winter,  breeding  is  arrested,  and  is  accom- 
panied by  cessation  of  menstruation  during  that  time  also; 
so  that  the  cold  which  stops  ovulation  also  stops  menstruatiofi. 

1  Macnaughton-Jones,  "  Diseases  of  Women,"  8th  ed.  1900,  p.  34. 

2  Alban  Doran,  "  Trans.  Obstet.  Soc."  vol.  xl.  1898,  p.  166. 


30  THE  CAUSATION  OF  SEX 

Dr.  E.  J.  Tilt^  mentions  that  the  surgeon  to  Sir  John 
Ross'  Arctic  expedition  reported  that  the  Esquimaux  women 
only  menstruate  during  the  summer  months. 

Because  instances  have  occurred  where  menstruation  (?) 
has  recently  happened,  and  no  trace  of  the  ripening  of  an 
ovum  has  apparently  been  found,  it  has  been  alleged  that 
menstruation  can  occur  without  ovulation.  This  statement 
must  be  accepted  with  great  reserve.  All  haemorrhages  in 
women  are  not  menstruation,  and  we  require  to  exclude 
several  conditions  and  morbid  growths  as  causes,  before 
deciding  that  the  haemorrhage  was  a  true  menstrual  period. 
We  should  not  forget  that  the  haemorrhage  from  bleeding 
piles  has  been  taken  for  menstruation  ! 

Then,  too,  failure  to  find  what  is  deemed  a  recently 
ruptured  Graafian  follicle  is  no  proof  that  ovulation  did  not 
occur,  and  it  is  probable  that  in  young  women  a  corpus 
luteum  of  menstruation  often  disappears  more  rapidly  than 
we  usually  expect,  and  thus  resembles  a  corpus  luteum  of 
a  former  ovulation,  and  so  is  not  ascribed  to  the  recent 
menstruation. 

Confirmatory  of  this,  W.  Williams^  says: 

"  In  young  women,  in  whom  the  circulation  is  active,  the  de- 
generated lutein  cells  are  rapidly  absorbed,  so  that  in  a  short  time 
the  corpus  luteum  becomes  replaced  by  newly  formed  connective 
tissue  which  corresponds  closely  in  appearance  to  the  surrounding 
ovarian  stroma." 

Some  other  cases  may  be  explained  thus;  Leopold,^  quoted 
by  Heisler,  says:         ^ 

"  If  rupture  (of  a  Graafian  follicle  and  extrusion  of  the  ovum) 
occurs  during  the  intermenstrual  period  instead  of  at  the  time  of 
menstruation,  haemorrhage  will  be  small  or  entirely  wanting,  the 
resulting  corpus  luteum  being  called  then  atypical,  to  distinguish  it 
from  the  typical  body  formed  in  the  ordinary  manner." 

Again,  haemorrhage,  after  the  menopause  or  change  of 
life,  often  erroneously  taken  for  menstruation,  is  necessarily 
unaccompanied  by  the  formation  of  a  corpus  luteum  in 
either  ovary. 

1  Dr.  E.  J.  Tilt,  "  Diseases  of  Women,"  1853,  p.  112. 

2  Williams,  op.  cit.,  p.  68. 
^  Heisler,  op.  cit.,  p.  33. 


PHYSIOLOGY  31 

We  are  forced,  then,  to  agree  with  Horrocks'^  when  he 
says: 

"  There  are  no  facts  which  proved  that  menstruation  could  take 
place  without  ovulation." 

As  a  matter  of  fact,  menstruation  cannot  occur  if  all  ovarian 
tissue  is  absent;  it  is  absolutely  dependent  on  the  presence 
of  some  ovarian  tissue. 

1  Horrocks,  "  Trans.  Obstet.  Soc,"  vol.  xl.  1898,  p.  173. 


CHAPTER  III 
THE   FORMATION   OF  OVA 

In  the  human  embryo  the  surface  of  each  ovary  is  covered 
by  a  thick  layer  of  oblong  or  columnar  cells — the  germinal 
epithelium.  From  this  germinal  epithelium  all  the  ova  are 
eventually  developed. 

Downgrowths  of  the  covering  cells  or  germinal  epithelium 
take  place  into  the  substance  of  the  ovary,  and  from  these 
cells  thus  carried  into  the  stroma  of  the  gland  the  Graafian 
follicles  are  formed,  one  or  more  cells  being  specially  en- 
larged to  form  the  contained  ovum  or  ova. 

These  ingrowths  of  the  germinal  epithelium  take  place 
during  intra-uterine  life,  so  that  at  birth  the  child's  ovaries 
already  contain,  though  in  an  immature  form,  the  full 
number  of  ova  that  the  adult  ovaries  contain.  The  forma- 
tion of  new  ova  ceases  with  the  birth  of  the  child. 

It  will  thus  be  seen  that  all  the  ova  shed  during  a  woman's 
Ufe  are  highly  matured  cells,  whose  development  has  been 
slowly  taking  place  prior  even  to  the  woman's  own  birth. 

The  ova  are  not  the  result  of  hurried  growth,  but  of  careful 
and  very  deliberate  preparation  extending  over  many  years. 

No  new  Graafian  follicles  are  formed  after  birth,  but  as  the 
two  ovaries  together  are  estimated  at  puberty  to  contain 
some  70,000  Graafian  follicles  it  is  evident  that  only  a  very 
few  ever  reach  maturity.  The  majority  of  the  follicles 
never  ripen,  or,  if  they  do,  they  do  not  burst — they  atrophy 
and  disappear. 

Halliburton^  says: 

"  Some  of  the  Graafian  follicles  never  burst ;  they  attain  a  certain 
degree  of  maturity,  then  atrophy  and  disappear." 

The  human  ovum,  oocyte,  or  sexual  cell  is  a  spherical 
particle  of  viscous  protoplasm  of  a  complicated  chemical 

1  Halliburton,  "  Handbook  of  Physiology,"  5th  ed.  1903,  p.  801. 

32 


THE  FORMATION  OF  OVA  33 

composition,  varying  from  120  to  jio  in.  in  diameter;  it  is  a 
single  living  cell,  capable  of  further  growth  and  great  develop- 
ment if  fertilised. 

It  soon  dies  after  its  discharge  from  the  Graafian  follicle 
if  not  fertilised,  its  life  being  counted  by  days  only — thus 
differing  considerably  from  the  male  sexual  cell,  or  sper- 
matozoon, which  can  live  for  weeks  even,  in  the  Fallopian 
tube  of  a  woman. 

Though  our  microscopes  are  not  perfect  enough  to  enable 
us  to  detect  any  differences  between  them,  each  ovum  has,  I 
maintain,  its  own  definite  and  unalterable  sex,  being  either 
male  or  female,  according  to  the  ovary  from  which  it  is 
derived. 

And  in  the  same  way,  the  ovum  of  one  woman  is  indistin- 
guishable by  microscope  or  any  apparatus  from  the  ovum  of 
another  woman,  yet  we  know  there  must  be  vast  differences 
between  them;  similarly  the  ovum  of  a  negress  is  indistin- 
guishable by  our  present  appliances  from  the  ovum  of  a 
blonde,  yet  we  know  full  well  that  if  fertilised  the  one  pro- 
duces a  dark  child,  while  the  other  gives  rise  to  a  white  one. 

The  difference  must  be  there,  but  we  cannot  detect  it ;  it 
may  be  chemical  and  not  discernible  microscopically. 

And  in  animals,  just  as  surely  as  a  cat's  ovum,  indistin- 
guishable by  microscope  or  other  apparatus  from  that  of  a 
bitch,  will  give  rise  to  a  cat  and  not  a  dog,  so  a  male  human 
ovum,  though  we  cannot  yet  by  any  of  our  present  means 
distinguish  it  from  a  female  one,  will  as  surely  give  rise  to  a 
boy  and  not  a  girl,  and  vice  versa  the  female  ovum  gives 
rise  to  a  girl  and  not  a  boy. 

In  structure  an  ovum  is  a  typical  cell,  or  circular  mass  of  ^ 
protoplasm  with  a  very  fine  and  delicate  cell  wall  or  limiting 
membrane,  called  the  Vitelline  membrane  (see  Fig.  10). 
External  to  this,  but  separated  from  it  by  a  little  fluid 
(the  Peri  vitelline  fluid),  is  a  second  protective  cell  wall,  the 
Zona  pellucida  or  Zona  striata. 

The  peri  vitelline  fluid,  therefore,  occupies  the  perivitelhne 
space  between  the  true  and  the  secondary  cell  walls. 

The  zona  pellucida  (i,  Fig.  10)  exhibits  hundreds  of 
fine  lines  or  striae — hence  also  zona  striata — radiating  out- 
wards; these  fine  hair-like  lines  are  really  pores  or  canals, 

3 


34  THE  CAUSATION  OF  SEX 

so  that  this  cell  wall  is  a  porous  one.  Through  these  canals 
the  ovum  is  nourished,  and  through  these  "  avenues  of 
entrance  "  the  mov  ng  spermatozoa  enter  the  ovum  and  so 
reach  the  nucleus;  they  are  really  multiple  "ways  in" 
for  the  spermatozoa. 

In  this  respect  the  human  ovum  differs  from  those  of  the 
invertebrata,  which  have  only  one  such  opening  or  "  way 
in  "  for  the  spermatozoa,  called  the  micropyle;  but,  as  we 
shall  presently  see,  only  one  spermatozoon  is  required  to 


Fig.  io. — Diagram  of  a  Human  Ovum.     (Much  magnified.) 

Though  this  diagram  represents  the  ovum  as  quite  flat,  it  must  be  remembered  it  is  a  sphere, 
and  more  nearly  resembles  a  miniature  orange  than  a  vertical  section  of  an  orange  as  the  figure 
would  appear  to  indicate.     Compare  Fig.  12. 

I,  Zona  Pellucida,  the  thick  cell  wall,  showing  radiating  lines,  which  are  pores  or  entrances  for 
the  spermatozoa.  2.  Perivitelline  space,  containing  the  Perivitelline  fluid.  3.  The  ovum 
filled  by  the  Yolk,  or  protoplasm  loaded  with  food  granules.  4.  The  nucleus  or  Germinal 
vesicle.     5.  The  nucleolus  or  Germinal  spot.     6.  Vitelline  membrane  or  delicate  ovum  wall, 

enter  the  ovum  of  the  invertebrata  in  order  to  fertihse  it, 
so  that  "  the  supply  is  equal  to  the  demand." 

The  contents,  yolk,  or  vitellus  of  the  cell  is  protoplasm, 
and  situated  eccentrically  therein  lies  the  spherical  nucleus, 
riff  in.  in  diameter,  called  the  germinal  vesicle,  and  this 
contains  a  nucleolus  known  as  the  germinal  spot.  The 
nucleus  or  germinal  vesicle  is  the  most  important  part  of  the 
whole  ovum  ;  it  is  usually  single,  but  there  may  be  two 
nuclei.     It  is  junction  with  the  nucleus  of  the  ovum  by  the 


THE  FORMATION  OF  OVA  35 

head  or  nucleus  of  the  spermatozoon  that  constitutes 
fertiHsation.  We  know  nothing  of  the  use  or  function  of 
the  nucleolus. 

To  the  protoplasmic  vitellus  or  germ  yolk  of  the  ovum  is 
added  material  called  deutoplasm  or  food  yolk,  designed  for 
the  nutrition  of  the  ovum  during  the  first  few  days  of  its 
development  after  fertilisation. 

The  germ  yolk  is  always  in  great  excess  compared  to  the 
food  yolk  in  a  human  ovum. 

All  ova  in  which  the  protoplasm,  or  germ  yolk,  and  the 
deutoplasm,  or  food  yolk,  are  uniformly  distributed,  as  in 
those  of  the  mammalia,  including  man,  are  known  as  Aleci- 
thai  ova. 

The  eggs  of  birds,  reptiles,  and  bony  fishes  arc  knoWn  as 
Telolccithal  ova ;  for  the  preponderating  food  yolk  is  accumu- 
lated at  one  part  of  the  ovum,  and  the  protoplasmic  germ 
disk  at,  usually,  the  opposite  pole. 

Note. — Some  of  the  statements  as  to  the  very  minute 
structure  of  cells  and  their  nuclei  must  be  accepted  with 
some  reserve,  for  in  the  staining  and  preparation  of  the  cells 
we  cannot  be  quite  sure  that  we  have  not  ourselves  caused 
the  appearances  so  described,  so  that  the  facts  may  be  really 
artificial  ones,  or  artifacts,  as  they  often  are  called.  Hence 
I  shall  not  detail  them,  as  they  do  not  now  concern  us. 


CHAPTER  IV 
THE  FORMATION  OF  THE  SPERMATOZOA 

The  spermatozoa  are  the  essential  fertilising  constituents 
of  the  semen;  they  float  in  an  albuminous  fluid,  the  liquor 
seminis. 

Each  spermatozoon  consists  of  a  head  eoVo  in.  long,  and 
a  long  slender  tail  from  j Jo  to  -5 Jo  in.  long;  a  middle  portion 
or  body,  thicker  than  the  tail,  is  also  described.  They 
therefore  slightly  resemble  miniature  tadpoles. 


Fig.  II. — Human  Spermatozoa.     (Highly  magnified.) 

H.  The  head,  showing  a  nucleus.     B.  The  body  or  middle  piece.    T.  Long  tail,  the  source 
of  the  motility  of  the  spermatozoon. 

The  spermatozoa  are  derived  from  the  spermatoblasts  or 
cells,  which  form  the  most  internal  lining  of  the  seminiferous 
tubes  or  seminal  canals  of  the  testes.  The  nucleus  of  the 
cell  forms  the  head  of  the  spermatozoon. 

The  long  tail  projects  into  the  lumen  of  the  seminal  tube, 
and  when  fully  developed  the  spermatozoon  is  set  free,  and 
is  probably  carried  to  the  vesiculae  seminales  or  receptacles 
for  the  storage  of  the  semen. 

No  spermatozoa  are  formed  till  after  puberty,  usually 
about  the  fifteenth  or  sixteenth  year;  any  seminal  fluid  in 
younger  boys  usually  containing  no  spermatozoa. 

Under  certain  conditions  in  man  the  formation  of  sper- 
matozoa is  very  rapid,  but  in  no  case  is  their  preparation 
such  a  long  and  careful  process  as  is  that  of  an  ovum. 

It  has  already  been  pointed  out  that  the  ova  are  all  formed 
before   the   child's   birth   even,    the   spermatozoa   not   till 

36 


THE  FORMATION  OF  THE  SPERMATOZOA     37 

puberty,  hence  the  ovum  is  a  far  more  slowly  matured  and 
specialised  cell  than  the  spermatozoon.  In  size,  too,  the 
ovum  is  much  the  larger  and  more  important.  The  diameter 
of  the  ovum  is  forty  times  greater  than  the  length  of  the 
spermatozoon's  head,  while  the  nucleus  or  essential  portion  of 
the  ovum  is  -io  in.  in  diameter ;  the  head  of  the  spermatozoon, 
containing  the  nucleus  or  essential  portion,  is  only  ^oVxy  in. 
long;  in  fact,  the  spermatozoa  are  the  smallest  cells  in  the 
body. 

The  spermatozoon  and  ovum  agree  in  that  each  is  a  small 
mass  of  protoplasm  containing  a  nucleus;  the  former  repre- 
sents a  portion  of  the  father's  body,  the  latter  a  portion  of 
the  mother's  body. 

The  long  tail  of  the  spermatozoon  is  essential  to  its  motility 
or  power  of  progression,  and  for  the  most  part  disappears 
after  the  spermatozoon  has  entered  the  ovum — that  is, 
when,  having  reached  its  goal,  it  is  no  longer  required. 


CHAPTER  V 
FERTILISATION 

Fertilisation  is  the  incorporation  of  the  essential  portion 
of  the  male  fertilising  fluid,  or  semen,  with  the  ovum  or  egg 
provided  by  the  female. 

The  ovum  before,  and  after,  fertilisation  are  two  vastly 
different  things:  the  unfertilised  cell  becomes  an  oosj)erm, 
zygote,  or  fertilised  cell,  which  differs  from  the  original  ovum 
not  only  in  its  chemical  composition,  but  also  in  its  power  of 
life  and  growth.  A  portion  of  the  male  parent's  body  has 
by  means  of  the  spermatozoon  joined  the  ovum  or  part  of 
the  mother's  body,  and  the  germ  of  a  new  being  begins  to 
grow. 

The  youngest  fertilised  human  ovum  or  oosperm  ever 
found  and  described  was  believed  to  be  the  one  by  Hubert 
Peters,  in  1897,  in  the  uterus  of  a  woman  who  committed 
suicide  three  days  after  missing  her  menstrual  period; 
therefore  it  was  at  first  claimed,  on  not  very  conclusive 
grounds,  to  be  of  only  three  days'  development:  but  we  do 
not  know  when  the  fruitful  coitus  took  place— it  may  have 
been  two  or  three  days  or  even  a  week  or  more  previous  to 
the  day  her  period  was  expected  to  begin,  hence  five  to 
fifteen  days  would  then  represent  its  age.  Though  con- 
sidered to  be  only  three  days  old  by  Peters,  the  ovimi, 
W.  Williams^  says,  "  certainly  presents  a  tolerably  ad- 
vanced stage  of  development." 

A  still  younger  oosperm  has  since  been  described  by  Drs. 
Brycc  and  Teacher,  who  claim  it  to  be  about  thirteen  to 
fourteen  days  old,  while  they  judge  Peter's  fertilised  ovum 
to  have  been  at  least  fourteen  to  fifteen  days  old. 

Graf  Spec  has  described  two  very  early  fertilised  human 
ova,  but  both  were  slightly  older  than  that  of  Peters. 

1  Whitridge  Williams's    "  Obstetrics,"  p.  cS8. 
38 


FERTILISATION  39 

The  youngest  I  have  personally  met  with  was  certainly 
less  than  fourteen  days  old. 

If,  therefore,  the  youngest  oosperm  ever  seen  was  at 
least  thirteen  days  old,  it  follows  that  the  actual  fertilisation 
of  the  human  ovum  has  never  been  observed,  hence  the  minute 
processes  and  early  phenomena  incidental  to  the  fertilisation 
of  the  human  ovum  are  quite  unknown,  as  Dr.  J.  W.  Ballan- 
tyne^  says: 

"  No  biologist  and  no  embryologist  has  ever  seen  the  human 
ovum  entered  by  the  human  spermatozoon." 

Dr.  Eden^  rightly  says:  "The  details  of  the  process  of 
fertihsation  naturally  cannot  be  studied  in  the  human 
species";  so  that  the  descriptions  given  in  many  books  as 
entirely  applicable  to  man  are  but  assumptions,  based  on 
observations  made  chiefly  on  the  invertebrata,  the  round- 
worm of  the  horse  especially. 

Indeed,  very  few  if  any  men  have  even  seen  a  free  human 
ovum,  that  is,  one  discharged  naturally  from  its  Graafian 
follicle,  and  most  observations  have  been  made  on  ova 
artificially  removed  from  the  follicles  either  after  death  or 
while  operating  under  chloroform,  etc. 

We  are  equally  ignorant  with  regard  to  most  animals, 
and  Dr.  Eden^  tells  us: 

"  The  beginnings  of  development  have  not  yet  been  made  out 
with  precision  in  any  of  the  mammalia." 

The  actual  contact  of  the  spermatozoon  with  the  nucleus 
of  the  ovum  not  having  been  observed,  it  is  impossible  to 
say  how  many  human  spermatozoa  are  required  to  fertilise 
the  human  ovum. 

From  analogy  it  has  been  believed  and  dogmatically 
taught  that  only  one  spermatozoon  was  necessary :  this  may 
be  so,  but  it  is  also  open  to  doubt.  One  spermatozoon  only 
may  be  sufficient,  but  it  is  also  quite  possible  that  very  often, 
if  not  usually,  many  spermatozoa  participate.  And  here  it 
is  advisable  to  recall  Dr.  f.  W.  Ballantynes  ^  warning  that 

1  Ballantyne,  "  Manual  of  Antenatal  Pathology,"  p.  608. 

2  Dr.  T.  W.  Eden,  "  Manual  of  Midwifery,"  4th  ed.  1915.  P-  lo- 

3  Eden  in  Playfair's  "  Midwifery,"  1898,  p.  88. 
*  Ballantyne,  op.  cit.,  p.  24. 


40  THE  CAUSATION  OF  SEX 

"it  is  not  safe  to  conclude  that  what  occurs  in  the  lower 
animals  will  occur  in  the  human  subject." 

Fertilisation  of  the  frog's  egg  and  also  of  the  transparent 
ova  of  several  of  the  invertebrates,  e.g.  thread-worms  and 
sea-urchins,  has  been  actually  watched.  In  them  only  one 
spermatozoon  has  been  seen  to  enter  the  ovum,  through  the 
only  opening,  called  the  micropyle,  in  the  tunic  or  wall  of  the 
ovum;  hence  it  has  been  assumed  that  only  one  likewise 
enters  the  human  ovum.  Though  the  entrance  of  but  one 
spermatozoon  is  usual,  according  to  among  others  Van 
Beneden,  he  has  actually,  though  on  but  few  occasions,  seen 


Fig.  12. — Magnified  View  of  a  Human  Ovum  removed  from  a 
Graafian  Follicle.     (Diagrammatic.) 

The  spherical  ovum  has  been  cut  vertically  and  horizontally,  to  show  that  the  cell-wall  is  uni- 
versally perforated  by  the  porous  canals  for  the  entrance  of  the  spermatozoa.  The  outer 
surface  of  the  ovum,  2,  shows  the  minute  puncta  or  orifices  of  the  canals,  which  are  shown 
in  I  as  radiating  lines ;  3  shows  the  interior  of  the  ovum  from  which  the  nucleus  and  the 
liquid  yolk  have  escaped. 

two  spermatozoa  enter  one  ovum,  while  watching  the  fertili- 
sation of  the  eggs  of  the  ascaris. 

Comparative  embryology  is  at  best  a  doubtful  guide,  and 
that  it  is  dangerous  to  argue  from  analogy  is  evident  from 
the  fact  that  there  are  marked  differences  in  the  ova  of 
the  mammalia,  including  the  human  ovum,  and  the  ova  of 
the  fishes,  birds,  or  reptiles,  the  ova  of  the  latter  being  mero- 
blastic  and  telolecithal,  while  the  human  ovum  is  holoblastic 
and  alecithal. 

A  merohlastic  ovum  means  that  a  portion  only  of  the  ovum 
when  fertilised  divides  or  segments,  and  it  contains  more 
food  yolk  than  germ  yolk,  as  it  has  to  develop  independently 
of  the  mother;  while  in  the  holoblastic  ovum  the  whole 


FERTILISATION  4^ 

substance  divides  and  subdivides,  it  contains  much  more 
germ  yolk  than  food  yolk,  because  the  mammalian  embryo 
very  early  derives  its  food  supply  from  the  mother  while 
in  utero. 

It  is  possible  that  this  initial  fundamental  difference  in 
the  ova  is  sufficient  to  require  the  different  number  of 
spermatozoa,  more  being  required  when  the  whole  ovum 
segments  as  does  the  human  ovum. 

There  is  no  micropyle,  or  specialised  "  way  in,"  provided 
in  the  cell  wall  of  the  human  ovum  for  the  entrance  of  the 
spermatozoa;  on  the  other  hand  there  are  multiple  openings, 


Fig.  13. — Magnified  View  of  the  Ovum  of  an  Invertebrate. 

The  spherical  ovum  presents  one  large  opening,  the  micropyle,  "  the  only  way."  for 
the  spermatozoon. 

actually  many  thousands,  in  the  human  ovum  wall,  so  it  is 
only  reasonable  to  suppose  that  at  least  hundreds,  if  not 
thousands,  of  spermatozoa  do  enter  the  ovum  by  them  and 
so  reach  the  protoplasm  or  yolk  of  the  ovum,  whence  it  is 
possible  that  several  also  enter  the  nucleus  of  the  ovum. 

That  the  striae  in  the  zona  pellucida  are  for  the  passage 
of  the  spermatozoa  is  stated  by  Gerrish^  who  says : 

"  The  zona  pellucida  is  marked  by  numerous  radiating  striae.  The 
striae  are  supposed  to  be  minute  canals,  through  which  nutrition 
reaches  the  ovum  while  it  is  still  in  the  Graafian  follicle,  and  through 
which  the  spermatozoa  may  afterwards  pass  in  the  process  of 
fecundation." 

Cunningham^  too  says  "  they  allow  the  spermatozoa  to 
reach  the  ovicell." 

^  Gerrish,  "  Text-book  of  Anatomy,"  2nd  ed.  1903,  p.  852. 
2  Cunningham,  op.  ciL,  p.  12. 


42  THE  CAUSATION  OF  SEX 

Hcisler^  also  confirms  this,  and  points  out  that  these 
canals 

"  correspond  in  junction  to  the  micropyle,  a  small  aperture  found  in 
the  less  easily  penetrable  egg  envelopes  of  many  invertebrates,  and 
of  some  fishes." 

In  the  invertebrata,  therefore,  the  supply  is  equal  to 
the  demand — viz.  one  micropyle  for  one  spermatozoon. 
Hence,  in  those  cases  where  there  is  only  the  single 
micropyle  or  special  "  way  in  "  provided  in  the  ovum 
wall,  we  should  expect  that  one  spermatozoon  enters 
thereby  only,  because  only  one  spermatozoon  is  needed. 
Certainly  the  provision  in  the  human  ovum  of  multiple 
avenues  of  entrance  looks  as  though  multiple  spermatozoa 
are  required  to  enter  thereby,  in  order  to  fertilise  the  human 
ovum ;  or  does  the  supply  far  exceed  the  demand — thousands 
of  ways  in  for  only  one  spermatozoon  !  It  would  be  more 
rational  to  expect  hundreds  of  spermatozoa  for  every 
"  way  in  ";  which  there  probably  are,  as  the  total  number 
of  spermatozoa  in  a  single  seminal  ejaculation  has  been 
estimated  at  several  millions. 

It  is  certainly  evident,  as  stated  by  Dr.  J.  W.  Ballantyne,^ 
that  "  what  took  place  in  the  chick  did  not  necessarily  occur 
in  the  human  embryo  ";  and  even  more  truly  what  takes 
place  in  the  ova  of  worms  and  sea-urchins  need  not  occur 
in  the  human  oosperm.  Indeed,  Dr.  J.  Teacher^  says  that 
"  each  ovum  seems  to  be  a  law  unto  itself." 

Nature  would  hardly  be  so  prolific  in  her  supply  of  human 
spermatozoa  to  the  single  ovum  if  one  only  were  necessary ; 
for  certainly  the  enormous  number  of  spermatozoa  provided 
each  time,  and  their  very  frequent  renewal,  and  their  long  life 
in  the  Fallopian  tubes,  point  rather  to  the  necessity  of 
multiple  spermatozoa. 

Nature  may  well  require  only  a  single  spermatozoon  for 
each  ovum  in  those  cases  where  sexual  congress  and  fertilisa- 
tion are  an  annual,  or  at  most  a  half-yearly  occurrence,  and 

1  Heisler,  op.  cit.,  p.  23. 

2  Ballantyne,  "Journal  of  Obstetrics  and  Gynaecology,"  1902,  vol.  i., 
p.  698. 

3  Dr.  J.  Teacher,  "  Journal  of  Obstetrics  and  Gynaecology,"  July,  1903, 
vol.  iv.  p.  25. 


FERTILISATION  43 

the  ova  to  be  fertilised  are  numbered  by  thousands  or  even 
hundreds  of  thousands. 

Polyspermy,  or  the  entrance  of  multiple  spermatozoa  into 
the  ovum  nucleus,  has  been  blamed  for  the  production  of 
human  deformities  on  no  reliable  evidence ;  for  who  sees  the 
fertilisation  of  the  ovum  when  a  monstrosity  is  produced  ? 
It  has  also  been  blamed  for  the  production  of  twins  and  plural 
births  on  equally  inaccurate  data,  for  we  know  that  usually 
when  these  occur  multiple  ova,  as  evidenced  by  multiple 
corpora  lutea,  have  been  produced. 

Normal  Site  of  Fertilisation. — There  is  every  reason 
to  believe  that  fertilisation  usually  takes  place  in  the 
Fallopian  tube,  and  not  in  the  uterus ;  if  the  uterus  were  the 
proper  site  for  fertilisation,  then  tubal  pregnancies  should 
not  occur  so  frequently. 

The  discovery  in  utero  of  an  early  fertilised  ovum  is  no 
proof  that  that  ovum  was  not  already  fertilised  when  it 
first  reached  the  uterus;  on  the  other  hand,  tubal  pregnancies 
are  so  numerous  that  they  must  be  looked  upon  as  cases  of 
abnormal  arrest  of  a  normally  fertilised  ovum  in  its  progress 
along  the  tube,  and  not  as  cases  of  abnormal  fertilisation 
in  an  abnormal  site. 

We  are  forced,  then,  to  the  conclusion  that  the  actual 
site  where  fertilisation  normally  takes  place  is  the  Fallopian 
tube;  probably  it  occasionally  occurs  in  the  body  of  the 
uterus,  as  it  undoubtedly  also  does,  on  very  rare  occasions, 
in  the  recently  ruptured  Crraafian  follicle  on  the  surface  of 
the  ovary;  hence  the  site  of  fertilisation  is  not  identical 
in  all  cases. 

Garrigiies^  says: 

"  The  Fallopian  tubes  are  the  canals  through  which  the  ova  pass 
from  the  ovaries  to  the  uterus,  and  in  which  probably,  in  most 
cases,  impregnation  takes  place  by  the  union  of  an  ovum  and  one 
or  more  spermatozoids." 

Halliburton  ^  says : 

"  The  spermatozoa  make  their  way  into  the  Fallopian  tubes. 
It  is  here  that  they  meet  the  mature  ovum." 

1  Garrigues,  "  Diseases  of  Women,"  3rd  ed.  1900,  p.  68. 

2  Halliburton,  op.  cit.,  p.  881,  1915. 


44  THE  CAUSATION  OF  SEX 

So  usual  is  it  for  spermatozoa  to  be  found  waiting  for 
the  ovum  in  the  Fallopian  tubes  of  women  in  whom  sexual 
congress  regularly  occurs,  that  the  Fallopian  tubes  are  now 
regarded  as  receptacles  for  the  semen. 

Most  often,  then,  the  fertilisation  of  the  ovum  and  its 
conversion  into  an  oosperm  takes  place  in  the  Fallopian 
tubes,  both  in  women  and  the  mammalia;  it  then  safely 
makes  the  journey  down  the  Fallopian  tube  to  the  uterus, 
which  is,  in  fact,  the  incubator  or  nest  for  the  fertilised  egg. 

On  its  arrival  there,  it  finds  a  bed,  or  nidus,  in  the  shape 
of  a  thick  vascular  mucous  membrane,  into  which  the  ovum 
sinks,  and  thus  secures  a  safe  resting-place. 

The  site  where  it  anchors  or  embeds  itself  is  usually  either 
the  anterior  or  posterior  wall  of  the  uterus,  but  may  be  at 
any  part  of  the  uterine  wall,  even  low  down  near  the  cervix, 
as  in  cases  of  placenta  praevia.  To  whatever  part  it  attaches 
itself,  the  now  living  and  growing  ovum  practically  eats  or 
bores  its  way  into  the  substance  of  the  congested  mucous 
membrane,  and  the  result  of  the  activity  displayed  by  the 
growth  and  the  fixation  of  the  oosperm  is  that  the  mucous 
membrane  does  not  degenerate  and  wither,  but  maintains 
its  integrity  and  position,  and  thus  menstruation  is  arrested : 
the  woman  is  pregnant. 

If  the  ovum  set  free  be  not  fertilised,  menstruation  occurs 
— that  is,  haemorrhage  occurs  from  the  congested  superficial 
vessels,  and  portions  of  the  epithelial  lining  of  the  congested 
uterine  mucous  membrane  degenerate  and  are  shed. 

The  site  of  attachment  of  the  oosperm,  the  future  placental 
site,  is  usually  in  the  corresponding  half  of  the  uterus  to 
the  Fallopian  tube  it  has  just  travelled  down.  Garrigties^ 
says:  "The  fertilised  ovum  is,  as  a  rule,  arrested  near 
the  internal  opening  of  one  of  the  Fallopian  tubes  " — i.e. 
it  is  more  to  one  or  other  side  of  the  mid-line  of  the  anterior 
or  posterior  uterine  wall;  it  may  be  quite  on  the  lateral 
wall;  or  it  is  in  the  corresponding  cornu,  or  uterine  horn, 
if  the  uterus  be  a  double  one.  In  the  uniparous  mammalia, 
too,  the  site  of  attachment  (placental  site)  is  usually  in  the 
corresponding  horn  to  the  ovary  from  which  the  ovum  was 
derived,  but  not  invariably  so. 

1  Garrigues,  "  Obstetrics,"  1902,  p.  29. 


FERTILISATION  45 

The  site  may,  however,  be  more  to  the  opposite  side  of 
the  uterus,  or  even  in  the  opposite  cornu  or  horn  if  the  uterus 
is  double;  or  again,  it  may  be  low  down  near  the  cervical 
orifice.  We  know  not  what  determines  its  precise  spot  of 
anchorage;  it  can  undoubtedly  travel  to  any  part  of  the 
uterine  wall. 

This  occurrence  of  implantations  of  the  oosperm  in  the 
horn  of  the  uterus  of  the  opposite  side  to  the  ovary  from 
which  the  ovum  was  derived,  has  long  been  known;  it 
occurs  both  in  women  and  in  mammals. 

It  may  be  due  either  to  the  ovum  passing  through  the 
uterus  from  one  side  to  the  other,  or  else  to  its  not  entering 
the  Fallopian  tube  on  its  own  side,  but  passing  along  the 
surfaces  of  the  intestines  to  the  other  side  of  the  uterus, 
where  it  thus  enters  the  opposite  Fallopian  tube.  This  is 
known  as  the  migration  of  the  ovum,  internal  and  external 
respectively.  I  reserve  the  full  discussion  of  the  matter  to 
Chapter  XIII. 

It  is  to  be  recalled  that  fertilisation  of  the  ovum  is  more 
correctly  fertilisation  of  the  ovum  nucleus.  An  account  of 
the  minute  details  after  fertilisation,  "  not  yet  proved  for 
human  beings,"-^  but  as  studied  in  starfish,  worms,  and  sea- 
urchins,  by  which  the  single  male  nucleus  and  female 
nucleus  approach  and  coalesce,  and  how  the  oosperm  thus 
formed  divides  or  segments,  to  form  the  primary  embryonic 
structures,  is  not  necessar\^  to  the  task  of  solving  the  cause 
of  sex  in  man,  and  so  I  do  not  describe  them. 

^  Whitridge  Williams,  "  Obstetrics,"  191 3,  p.  94. 


CHAPTER  VI 

THE  THEORY  AND  ITS  EXPLANATION 

There  being,  as  we  have  seen,  two  ovaries,  a  right  and  a 
left,  it  follows  that  the  ova  produced  are  either  right  or 
left  ova,  also  that  as  the  right  ovary  is  larger  than  the  left, 
more  right-sided  ova  are  usually  produced. 

If,  as  must  and  does  sometimes  occur,  the  two  ovaries 
each  happen  to  have  equally  matured  a  Graafian  follicle, 
we  get  a  simultaneous,  or  nearly  so,  rupture  of  the  follicles 
and  discharge  of  the  contained  ova;  that  is,  we  get  two 
ova  to  be  possibly  fertilised — for,  of  course,  this  does  not 
necessarily  always  occur. 

Should  fertilisation  of  both  occur,  we  get  two  foetuses,  or 
twins,  owing  their  origin  to  the  fertilisation  of  ova  from 
different  ovaries,  the  sexes  differing,  as  we  shall  see  later. 
This  is  not,  however,  the  only  mode  of  origin  of  twins, 
though  it  is  the  commonest;  but  I  will  refer  to  the  subject 
of  twins  further  on. 

Much  more  frequently  only  one  ovary  matures  a  follicle, 
and  a  single  ovum  only  is  produced :  if,  now,  as  the  result  of 
the  unilateral  ovulation,  the  single  ovum  be  fertilised,  we 
get  what  is  normal  in  mankind,  viz.  a  single  birth ;  if  double 
or  bilateral  ovulation  were  the  rule,  and  there  were  always 
two  ova  shed,  surely  both  would  usually  be  fertilised,  and 
twins  would  become  the  rule  and  single  pregnancies  the 
exception,  for  it  would  not  be  expected  that  if  two  ova 
were  always  provided,  one  only  would  be  fertilised  and  the 
other  left. 

This  brings  me  now  to  the  dominant  influence  of  the 
supplying  ovary  over  the  sex  of  the  resulting  foetus.  The 
supplying   ovary   is  in   reahty   the   essential   factor   in 

THE  CAUSATION  OF  SEX. 

This,  then,  is  my  theory,  that  the  sex  of  the  foetus  is 

46 


THE  THEORY  AND  ITS  EXPLANATION         47 

not  due  to  the  male  parent,  but  depends  on  which  ovary 
suppUed  the  ovum  which  was  fertihsed,  and  so  became  that 
foetus. 

I  find  that  a  male  foetus  is  due  to  the  fertihsation  of  an 
ovum  that  came  from  the  right  ovary,  and  a  female  foetus 
is  due  to  the  fertihsation  of  an  ovum  that  came  from  the 
left  ovary. 

I  will  explain  the  theory  more  in  detail. 

First,  then,  my  theory  maintains  that  the  male  parent 
or  father  has  no  influence  in  the  causation  of  sex,  which 
rests  entirely  with  the  female  or  woman.  She  has  in  her 
two  ovaries  the  already  definitely  sexed  ova  ready  only  for 
the  fertilising  action  of  the  male  semen,  so  that  though  man 
or  the  male  fertilises  the  ripened  ovum,  he  does  not  (to 
coin  a  word)  sexify  it  or  cause  its  sex. 

No  theory  which  I  can  discover  has  hitherto  entirely 
dissociated  the  male  parent,  as  1  do;  hence  it  is  entitled  to 
be  called  a  new  theory. 

Every  theory  in  which  the  father  is  credited  with  being 
even  partly  responsible  for  sex  causation  differs  materially 
from  mine. 

In  this  category  come  a  great  many  of  the  old  and  mythical 
theories.  These  in  differing  methods  and  ways  ascribed 
to  the  two  testicles,  if  not  the  chief,  at  least  a  great  part  in 
the  sexify  in  g  of  the  ovum. 

I  do  not  propose  to  enter  fully  into  these  theories,  none 
of  which  were  based  on  clinical  facts  or  cases,  but  will  only 
shortly  mention  their  chief  points. 

One  maintained  that  sex  was  entirely  due  to  the  male — 
that  the  spermatozoa  not  only  fertilised,  but  also  gave  the 
sex  to  the  ovum. 

Hippocrates  thought  that  the  future  sex  was  determined 
by  the  relative  prevalence  of  the  male  or  female  semen, 
either  as  to  the  quantity  of  it,  or  else  the  relative  strength 
of  it. 

Leeuwenhoek  went  so  far  as  to  suppose  he  could  see  a 
difference  of  sex  in  the  spermatozoa  upon  which  depended 
the  sex  of  the  future  foetus. 

Another  theory  maintained  that  fertilisation  could  only 
.take  place  by  the  jimction  of  the  spermatozoa  and  ova  of 


48  THE  CAUSATION  OF  SEX 

the  same  side  of  the  body,  so  that  a  left-sided  ovum  could  not 
be  fertilised  by  a  right-sided  spermatozoon,  and  vice  versa. 

This  theory  received  the  support  of  Hencke,  who  in  1786 
wrote  a  book  based  on  this  assumption,  also  claiming  that 
males  were  derived  from  the  union  of  right  spermatozoa 
with  right  ova  only,  and  girls  from  the  union  of  left  sper- 
matozoa only  with  left  ova  only.  This  theory  differs  there- 
fore widely  from  mine,  in  spite  of  several  critics,  because 
I  say  the  spermatozoa  do  not  influence  sex  at  all. 

I  fully  discuss  the  question  of  the  paternal  influence  on 
the  sex  of  the  future  child  in  Chapter  VII. 

Secondly,  my  theory  maintains  that  male  ova  are  re- 
stricted to  and  come  only  from  the  right  ovary,  and  female 
ova  only  from  the  left  ovary. 

It  matters  not  from  which  testicle  the  spermatozoon  is 
derived  which  fertilises  the  ovum,  the  essential  point  being 
that  sex  is  due  to  the  ova  always  having  their  definite  and 
unalterable  sex  prior  even  to  ovulation. 

It  follows  that  directly  an  ovum  is  fertilised,  a  boy  or  a 
girl  has  begun  to  be  developed,  and  no  external  or  other 
influence  brought  to  bear  on  the  mother  can  alter  the  sex 
of  the  future  child. 

To  inquire  why  the  ovary  of  the  right  side  should  have 
been  chosen  for  the  production  of  boys  rather  than  the  other 
side  seems  as  fruitless  and  as  useless  as  to  inquire  why  the 
liver  should  have  been  placed  to  the  right  and  the  spleen 
to  the  left  of  the  body. 

Galen  said  it  was  due  to  the  right  side  being  warmer  than 
the  left,  but  how  this  can  rank  as  cause  and  effect  I  know 
not. 

It  is,  however,  reasonable  to  suppose  that  the  association 
of  the  left  ovary  with  the  production  of  the  female  sex  is 
due  to  the  fact  that  the  muscularly  weaker  sex  should  arise 
from  the  muscularly  weaker  side  of  the  body. 

That  the  left  side  of  the  body  is  the  weaker  of  the  two 
is  manifestly  true,  for  as  Herman^  says: 

"  The  left  side  is  weaker  than  the  right,  not  only  in  muscular 
strength,  but  in  power  of  resistance  to  painful  impressions.  This 
is  illustrated  by  the  fact  that  in  cancer,  which  has  no  preference  for 

^  Herman,  op,  cit.,  p.  71, 


THE  THEQKY  AND  ITS  EXPLAKATION        49 

the  left  side  rather  than  the  right,  pain  is  more  common  on  the  left 
side.  So  it  is  in  displacements  of  the  uterus,  although  the  changes 
in  this  condition  have  no  unilateral  character;  and  iri  the  pain  down' 
the  thigh  from  haemorrhoids." 

So  that  the  muscularly  weakef  sex  are  derived  itom  the 
ovary  of  the  left  or  weaker  side,  while  the  larger  and  stronger 
males  come  from  the  larger  right  ovary.  Dr.  T.  G.  Moor- 
head'^  has  shown  that  a  child  even  at  birth  begins  its  "exist- 
ence with  a  marked  right-sided  bias." 

Taking  it  for  granted,  then,  that  only  one  ovum  is  pro- 
duced at  a  time,  the  question  comes,  from  which  ovary 
does  it  arise  ?  There  can  be  but  little  doubt  that  it  is  pj-o- 
vided  more  or  less  alternately  by  first  one  ovary  and  then 
the  other;  for  although  there  are  two  ovaries,  and  both  are 
normally  active,  they  do  not  work  synchronously  :  one  ovary 
only  discharges  an  ovum  at  a  time,  so  that  double  or  bi- 
lateral ovulation  is  not  normal.     Negrier^  says : 

"  The  ovaries  perform  alternately,  for  I  find  in  one  ovary  a  recently 
ruptured  follicle,  and  in  the  opposite  ovary  one  coming  forward." 

Further,  he  says  that : 

*'  In  women,  having  double  uterus  and  vagina,  the  menses  have 
com.e  from  each  side  alternately." 

A  case  published  recently  by  Jurinka  proves  this,  as  also 
does  a  case  of  Engel's  (cf.  pp.  170,  171). 

That  unilateral  ovulation  is  the  rule  is  proved  post  mortem 
by  cases  where  only  a  few  and  definite  number  of  menstrual 
periods  have  occurred.  We  are  then  able  to  see  and  count 
the  cicatricial  pits  or  scars,  the  remains  of  the  corpora 
lutea,  and  find  them  in  the  two  ovaries  together  to  equal  the 
number  of  periods  passed.  We  do  not  find  that  each  ovary 
has  pits  or  scars  equal  in  number  to  the  number  of  menstrual 
periods;  but  that  if,  for  example,  as  in  one  of  the  following 
cases,  only  three  periods  had  been  experienced  during  life, 
each  ovary  has  not  three  pits  or  scars,  but  the  two  ovaries 
have  three  scars  between  them. 

^  Dr.  T.  G.  Moorhead  in  "  Transactions  of  Royal  Academy  of  Medicine- 
Ireland,"  1902. 

2  Negrier,  "  Anatomical  and  Physiological  Researches  on  the  Human 
Ovary."     Paris,  1840. 


50  THE  CAUSATION  OF  SEX 

The  following  cases  support  and  prove  this : 

Mr.  Girdwood^  exhibits  a  preparation  taken  from  a  young 

unmarried  female  who  he  knew  had  menstruated  about 

thirty-six  times. 

"  The  ovaries  presented  several  indentations  or  small  cicatrices 
about  the  size  of  mustard  seeds.  From  thirty- two  to  thirty-four 
of  these  marks  could  be  detected — about  eighteen  in  one,  and 
sixteen  in  the  other  ovary." 

"  A  young  woman  died  under  my  care.  She  had  menstruated 
three  times.  The  surfaces  of  one  ovary  presented  two  cicatrices; 
that  of  the  other,  one." 

"  Jane   C ,    aged   eighteen,    died   of  consumption.     She   had 

menstruated  only  six  times.  We  could  readily  detect  five  depres- 
sions or  cicatrices — three  on  one,  two  on  the  other  ovary ;  of  a  sixth 
we  were  doubtful." 

I.e.  there  were  not  six  ovulation  scars  in  each  ovary,  but 
six  in  the  two  ovaries  together. 

"  Miss  G had  been  regular  for  two  years  previous  to  her 

sudden  death.  In  her  I  found  post  mortem  about  twenty-two  of 
the  usual  marks  on  the  ovaries." 

That  is  to  say,  there  was  definite  proof  of  twenty-two 
ovulations  by  the  two  ovaries  together,  not  by  each  ovary,  as 
there  would  have  been  had  ovulation  been  bilateral  every 
month. 

"  Emma  Bull  died  yesterday.  Two  years  ago  she  menstruated, 
this  being  the  first  and  only  time  she  had  ever  had  that  secretion. 
I  opened  the  body.  The  ovaries  were  plump  and  rather  larger  than 
usual,  soft  to  the  touch,  and  glistening.  There  was  no  mark  or 
scar  whatever  on  the  right  ovary;  but  on  the  left  there  existed  a 
reddish  part  about  the  size  of  a  mustard  seed,  which  had  quite  the 
appearance  of  an  ulceration  skinned  over." 

That  is,  one  menstruation,  one  ovulation  scar  in  one  ovary 
only. 

In  the  following  cases,  examination  of  the  ovaries 
during  menstruation  reveals  only  one  ovary  as  having 
just  ruptured  a  Graafian  follicle — that  is,  one  ovary  only 
has  ovulated. 

1  Braithwaite's  "  Retrospect  of  Medicine  and  Surgery,"  vol.  vii,  1843, 
pp.  261-3. 

2  R.  Lee,  "  Braithwaite's  Retrospect,"  vol.  i.  1840,  p.  397. 


THE  THEORY  AND   ITS  EXPLANATION        51 

Dr.  R.  Lee''— 

"  examined  the  body  of  a  young  woman  who  died  during  menstrua- 
tion from  inflammation  of  the  median  basilic  vein.  The  left  ovary 
was  larger  than  the  right,  and  at  one  point  a  small  circular  opening 
was  observed  in  the  peritoneal  coat,  which  led  to  a  cavity  of  no  great 
depth  in  the  ovary.     The  right  ovary  was  in  the  ordinary  state." 

' '  A  woman  under  twenty  years  of  age  died  suddenly  from  acute 
inflammation  of  the  lungs  while  menstruating.  A  red,  soft,  elevated 
portion  of  the  right  ovary  was  observed,  and  at  one  part  the  peri- 
toneal coat  to  a  small  extent  had  been  removed.  Under  the  open- 
ing was  an  enlarged  Graafian  vesicle  filled  with  transparent  fluid. 
The  left  ovary  presented  a  natural  appearance." 

Sir  J.  Bland-Sutton^  says: 

"  The  evening  before  the  operation  the  patient  commenced  to 
menstruate.  When  the  cyst  was  drawn  up  from  the  pelvis  a  small 
rounded  aperture  was  noted  in  the  peritoneal  covering,  from  which 
a  few  drops  of  blood  issued.  Examination  of  the  parts  showed  this 
to  be  a  recently  ruptured  follicle." 

That  is,  one  ovary  only,  though  in  this  case  partially 
occupied  by  a  tumour,  had  ruptured  a  Graafian  follicle, 
coincidently  with  the  onset  of  menstruation. 

Dr.  John  Phillips^  describes  a  case  of  a  woman  dying 
during  menstruation  from  purpura  haemorrhagica : 

"  In  the  right  ovary,  at  the  site  of  the  corpus  luteum,  there  was 
a  haemorrhagic  infarct  the  size  of  a  marble." 

In  this  case,  therefore,  menstruation  had  been  accom- 
panied by  unilateral  ovulation  and  the  formation  of  a  single 
corpus  luteum,  not  one  in  each  ovary. 

Garrigues^  says: 

"  The  fact  is,  we,  as  a  rule,  find  only  one  fully  developed  or  rup- 
tured follicle  corresponding  to  a  menstruation." 

We  are  therefore  justified  in  saying  that  the  number  of 
pits,  scars,  or  cicatrices  in  the  two  ovaries  being  nearly  equal, 
and  together  equalling  the  known  number  of  menstrual  periods 
experienced,  not  only  proves  unilateral  ovulation,  but  also 
necessarily  implies  that  such  ovulation  must  be  practically 
alternate  from  the  two  ovaries. 

1  Bland-Sutton,  "  Diseases  of  Ovaries,"  i8gi,  p.  46. 

^  J.  Phillips,  "  Trans.  Obstet.  Soc,"  vol.  xxxiii.  1891,  p.  395. 

^  Garrigues,  "  Obstetrics,"  1902,  p.  17. 


52  THE  CAUSATION  OF  SEX 

In  animals,  too,  in  whom  single  pregnancy  is  customary, 
only  one  ovary  ovulates  at  a  time.  This  is  borne  out  by  the 
observations  of  Heape^  on  monkeys.  These  animals  are 
monotocous — i.e.  have  but  one  at  a  birth — and  he  found 
the  ruptured  Graafian  follicle  on  one  side  only.  They  had 
"  a  more  or  less  prominent  discharged  follicle  in  one  or  other 
of  their  ovaries  " — that  is,  not  one  in  each  ovary — so  that 
ovulation  had  been  unilateral  and  not  bilateral. 

Of  course,  in  the  polytocous  animals — such  as  pigs, 
foxes,  dogs,  cats,  rats,  and  rabbits,  etc.,  where  multiple 
births  are  the  rule — each  ovary  ovulates,  and  yields  several 
ova.  It  is  only  when  the  ovaries  have  provided  ova  that 
the  female  animal  permits  insemination ;  hence  both  ovaries 
in  the  polytocous  animals  act  at  the  same  time. 

I  have  found  as  many  as  eight  corpora  lutea  in  one  ovary 
of  a  rabbit,  and  six  more  in  the  opposite  one,  fourteen  in 
all;  while  five  corpora  lutea  in  each  of  a  sow's  ovaries  is 
not  a  very  unusual  number. 

Every  theory  of  the  causation  of  sex  hitherto  brought 
forward,  other  than  the  association,  in  some  way  or  other, 
of  the  right  side  with  the  production  of  the  male  sex  and 
the  left  for  the  female  sex,  has  been  met  and  answered  by 
a  diametrically  opposite  or  contradictory  theory;  thus — 

Canestrini  maintained  that  sex  was  due  to  the  number 
of  spermatozoa  which  entered  the  ovum.  The  greater 
the  number  of  spermatozoa  the  more  male  children  are 
produced;  a  few  lead  to  girls  being  born. 

Dr.  J.  Ross  ("  Lancet,"  1884,  p.  48)  held  just  the  opposite; 
he  says:  "  A  few  spermatozoa  lead  to  male  offspring." 

Geddes  and  Thomson  ascribed  the  production  of  males  to 
a  katabolic  habit  of  body,  and  of  females  to  an  anabolic 
habit. 

Dr.  Andrew  Wilson,  F.R.S.E.  {"  Lancet,"  1891,  p.  713), 
says  exactly  the  opposite:  an  anabolic  habit  of  body  pro- 
duces males,  a  katabolic  habit  of  body  produces  females. 

The  theory  that  sex  is  dependent  on  the  relative  ages  of 
the  parents  led  to — 

1  Heape,  "  Trans.  Obstet.  Soc."  vol.  xl.  1898,  p.  167. 


THE  THEORY  AND  ITS  EXPLANATION        53 

Hofacker  and  Sadler  maintaining  that  the  older  parent 
produced  its  own  sexed  offspring. 

This  was  directly  contradicted  from  a  larger  number  of 
cases  by — 

Berner  and  Stieda,  who  held  that  the  younger  parent 
produced  its  own  sexed  offspring. 

Girou  promulgated  the  comparative  vigour  theory — that 
the  stronger  parent  produced  its  own  sexed  children,  so  that 
if  a  woman  were  the  stronger  a  girl  was  born. 

Vilson,  Romme,  Van  Lint,  and  others,  say  just  the  oppo- 
site— viz.,  that  the  weaker  parent  produces  its  own  sexed 
children,  or  the  stronger  parent  breeds  the  opposite  sexed 
child  to  itself,  and  thus  a  stronger  woman  should  breed  boys. 

Mayerhofer  advanced  the  view  that  it  was  the  fresh  and 
unexhausted  state  of  the  father  which  led  to  male  offspring, 
so  that  when  a  bull  or  ram  was  fresh  and  newly  turned 
among  the  cows  or  ewes  he  bred  more  males  or  his  own  sex. 

Dr.  P.  Tiickey  ("  British  Medical  Journal,"  January  19, 
1 901)  says  just  the  opposite — that  when  a  bull  or  ram  is 
newly  turned  out  among  the  herds  of  cows  or  ewes,  the 
offspring  of  the  females  served  early  were  mostly  females; 
the  later  ones  were  males:  that  is,  when  the  father  was 
fresh  and  not  exhausted  he  bred  the  opposite  sex. 

The  theory,  supported  by  Robin  and  by  Burdach,  that 
infrequent  sexual  intercourse  leads  to  female  children  has 
been  met  by  the  opposite  one  held  by  Mayerhofer~t\idX  in- 
frequent intercourse  is  responsible  for  the  production  of  boys. 

This  fact  I  have  here  alluded  to,  that  nearly  every 
invented  theory  has  found  someone  else  bring  forward 
another  theory  exactly  opposite  to  it,  is  proof  that  neither 
of  them  could  be  the  correct  solution  of  the  problem  of  the 
causation  of  sex. 

But  the  exception  to  the  above  statement  is  the  theory 
which  I  propound — ^viz.  that  the  male  parent  has  nothing 
to  do  with  the  sex  of  the  offspring,  which  is  absolutely  the 
prerogative  of  the  woman  or  female  parent,  who  has  in  her 
two  ovaries  the  different  sexed  ova — the  male  in  the  right 
ovary,  the  female  in  the  left  ovary. 


54  THE  CAUSATION  OF  SEX 

This  theory  receives  considerable  confirmation  from  the 
fact  that  the  right  side  of  the  body  in  both  the  male  and 
female  parents  has  always  been  allocated  to  the  production 
of  the  male  sex,  and,  vice  versa,  the  left  side  has  always  been 
attributed  to  the  female  sex. 

By  this  I  mean  that  no  one  has  ever  yet,  as  far  as  I  can 
discover,  introduced  an  opposite  theory,  in  which  the  right 
side  has  w  any  way  whatever,  or  in  either  parent,  been  held 
responsible  for  the  production  of  girls,  or  that  the  left  side 
produced  boys. 

My  theory,  then,  is  remarkable  as  the  only  exception  to 
the  rule  that,  given  a  theory,  an  opposite  or  contradictory 
one  is  soon  brought  forward  to  disprove  it. 

In  various  ways  and  ideas,  then,  the  right  side  has  always 
been  assigned  to  the  male,  and  the  left  side  to  the  girls  or 
females.     Thus — 

The  secretion  of  the  right  testicle  plus  that  from  the  right 
ovary  together  produced  boys,  according  to  Hippo- 
crates, Anaxagoras,  and  later  /.  Hencke. 

The  right  side  in  both  parents,  because  it  was  the  warmer, 
produced  boys,  according  to  Galen. 

Turning  by  the  woman  on  to  her  right  side  after  coition, 
to  ensure  semen  falling  into  the  right  side  of  uterus, 
produced  boys,  according  to  Avicenna  of  Ispahan. 

Habitually  sleeping  on  the  right  side  of  the  wife  produced 
boys,  according  to  T.  B.,  "  Lancet,"  1870. 

Sex  is  due  to  the  spermatozoa  only:  the  right-sided 
spermatozoa  are  male,  and  produce  boys,  according  to 
Michael  Scott. 

Sex  is  due  to  the  ova  only:  the  right-sided  ova  are  male, 
and  produce  boys,  according  to  E.  Rumley  Dawson. 

Further,  when  pregnancy  is  present  it  has  been  said  by 
Albertus  Magnus  : 

If  a  pregnant  woman  in  walking  moves  her  right  foot 

before  her  left,  she  will  have  a  boy. 
If  in  a  pregnant  woman  the  right  breast  is  harder  and 

larger,  she  will  have  a  boy. 


THE  THEORY  AND  ITS  EXPLANATION         55 

The  following  facts  also  serve  to  show  in  different  ways 
the  allocation  of  the  right  side  to  males: 

Men,  Havelock  Ellis  says,  have  better  sight  with  the  right 
eye,  women  better  sight  with  the  left  eye ;  and  in  domestic 
matters  it  is  curious  that  men  have  the  buttons  on  the  right, 
women  have  their  buttons  on  the  left  side  of  their  clothes ; 
and  whereas  men  usually  put  the  right  arm  first  into  their 
coats,  women  usually  begin  with  the  left.  But  why  there 
is  this  difference  I  have  been  unable  to  discover.  The  name 
Benjamin,  too,  is  suggestive. 


CHAPTER  VII 

DOES  THE  MALE  PARENT  OR  FATHER 
INFLUENCE  THE  SEX  OF  THE  COMING 
CHILD? 

It  will  come  as  a  serious  blow  to  the  vanity  of  man  to  know 
that  this  question  must  be  answered  with  a  decided  negative. 
Man,  or  the  male,  has  nothing  to  do  with  the  causation  of 
the  sex  of  the  future  child  .^ 

In  the  act  of  insemination,  the  semen  comes  via  the 
ejaculatory  ducts  from  both  testicles  simultaneously,  and 
from  the  reservoirs  or  vesiculae  seminales  which  store  the 
secretion  from  both  the  testicles.  Out  of  this  mixture  of 
spermatozoa  from  the  two  testicles,  some  chance  spermato- 
zoon fertilises  the  carefully  prepared  and  sexually  distinct 
ovum  derived  from  a  single  ovary.  Which  spermatozoon^ 
from  the  number  which  collect  around  an  ovum  actually 
does  fertilise  the  single  ovum  nucleus  must  be  purely  a 
matter  of  chance,  but  man's  part  in  fertilisation  and  genera- 
tion has  ceased  with  the  supplying  of  this  single  chance 
spermatozoon.  Can  we  credit,  then,  that  this  sperm-cell, 
rapidly  formed  in  the  testis,  can  be  the  instrument  chosen 
from  among  hundreds  of  thousands  of  others  to  determine 
the  sex  of  the  future  child  ? 

Its  life-history  is  so  short,  and  its  successful  junction  with 
the  ovum  so  much  a  matter  of  chance,  that  it  compares  very 
unfavourably  with  the  ovum,  which,  though  truly  only  a 
single  cell,  has  enjoyed  almost  a  monopoly  in  the  maternal 
production. 

1  This  statement  seems  to  have  much  perturbed  one  of  the  critics  of 
my  book;  for,  reviewing  it  in  a  scientific  journal,  he  opined  that  not  only 
was  I  "  not  justified  in  making  the  statement,"  but  that  "  this  part  of  the 
theory  asks  us  to  accept  too  much";  for,  wrote  he,  "without  a  male  there 
will  be  no  offspring,  either  daughters  or  sons  "  !  Could  criticism,  con- 
sidered crushing,  be  more  frivolous  or  inane  ? 

I  here  assume  that  only  one  spermatozoon  is  requisite  for  fertilisation. 

56 


DOES  THE  FATHER  INFLUENCE  THE  SEX  ?     57 

This  ovum,  which  was  present  in  its  mother's  ovary 
prior  even  to  her  own  birth,  has  been  carefully  preserved  for 
some  twenty-five  years ;  if  the  woman  is  of  that  age,  and  for 
some  months  has  been  an  object  of  careful  preparation  and 
maturation,  it  is  therefore  no  chance  production.  It  carries 
with  it,  I  say,  its  definite  unalterable  sex,  and  awaits  only 
fertilisation. 

That  the  human  ova  have  their  sex  already  definitely 
fixed  prior  even  to  their  dehiscence,  I  stated  in  my  paper 
in  the  Obstetrical  Society's  "  Transactions "  for  1900, 
vol.  xlii.,  p.  356.  The  male  ova  arise  from  the  right  ovary 
and  the  female  from  the  left  ovary,  so  that  the  female 
infant  is  born  with  her  primitive  ova  already  either  male  or 
female,  and  thus  the  causation  of  sex  comes  to  be  dependent 
on  the  woman  alone. 

From  a  leading  article  in  "  The  British  Medical  Journal"^ 
I  see  that  Dr.  Lenhossek,  Professor  of  Anatomy  at  the 
University  of  Budapest,  has  quite  recently  expressed  a 
similar  belief.  He  says  the  sex  of  the  offspring  is  determined 
before  impregnation  takes  place. 

"  It  follows,  then,  that  the  sex  of  the  offspring  is  decided  not 
by  both,  but  by  one  only  of  the  parents,  and  Professor  Lenhossek 
is  of  opinion  that  biological  experiments  show  that  it  is  the  mother, 
and  not  the  father,  that  possesses  this  power.  The  sex  of  the  ovum 
is  fixed  before  the  spermatozoon  fertilises  it." 

That  our  microscopes  are  not  at  present  powerful  or 
complete  enough  to  differentiate  a  male  from  a  female  ovum 
is  admitted,  but  we  may  by  an  improved  microscope  or 
Rontgen  or  other  rays  be  able  to  some  day  thus  recognise 
a  difference  in  them. 

To  quote  again  from  "  The  British  Medical  Journal  " : 

**  The  ova  in  the  human  subject,  and  in  many  of  the  animals,  do 
not  indeed  show  any  sexual  dissimilarity  either  in  their  histological 
or  in  their  chemical  characters;  but  similarity  in  these  details  may 
be  only  apparent,  not  real.  Nature  is  constantly  teaching  us  that 
dissimilarity  may  exist  when  we  cannot  perceive  it.  He  is  a  bold 
histologist  who  will  nowadays  maintain  that  no  difference  exists 
between  two  masses  of  protoplasm  simiply  because  his  microscope 
reveals  to  his  eye  no  difference  between  them." 

^  May  9,  1903,  p.  iioi. 


58  THE  CAUSATION  OF  SEX 

I  have  already  said  the  causation  of  sex  is  dependent  on 
the  woman  alone ;  it  comes  to  be  essentially  her  prerogative. 
She  prepares  an  ovum  (male  or  female)  in  much  the  same 
way  as  a  parlour-maid  prepares  and  lays  a  fire — it  may  be  a 
coal  or  a  wood  one — and  waits  for  the  match  to  be  applied 
before  the  fire  develops.  The  application  of  the  match  to  the 
fire  in  the  grate,  whether  wood  or  coal,  starts  the  fire — it 
does  not  make  a  coal  fire  into  a  wood  one  or  vice  versa  ;  and 
in  a  similar  manner  the  penetration  of  the  spermatozoon 
•into  the  prepared  ovum  starts  the  process  of  development 
of  a  child,  a  boy  or  girl  being  produced  according  to  which 
ovary  prepared  the  ovum.  Hence  the  part  played  by  man 
is  that  of  applying  the  match  or  stimulus  which  starts  the 
process  of  development  and  growth  of  the  offspring  from  the 
ovum.  Man,  in  fact,  is  the  fire-lighter,  not  the  fire-layer, 
Man  fertilises  the  ovum ;  he  does  not  sexify  it. 

Aristotle  long  ago  held  that  woman  supplied  the  primary 
material  for  the  development  of  the  future  individual; 
and  it  was  the  function  of  the  man  to  give  the  impulse  in 
consequence  of  which  the  future  individual  came  into 
being:  I  now  apply  this  to  sex  causation.  The  woman 
supplies  a  definite  and  unalterable  sexed  ovum,  the  pros- 
pective maleness  or  femaleness  of  her  ova  being  fixed  prior 
even  to  her  own  birth;  man  supplies  the  stimulus  which 
causes  the  first  steps  in  the  child's  development;  together 
the  man  and  woman  impart  to  it,  in  varying  degree,  its 
individuality,  its  heredity,  its  ancestral  characteristics  and 
likenesses. 

We  shall  now  see  how  clinical  facts  and  cases  support 
these  views:  that  the  male  parent  does  not  influence  the 
sex  of  the  coming  child  is  proved  by  such  cases  as  these, 
where  a  woman  has  one-sexed  children  only  by  different  men  ; 
thus: 

Mrs.  V.  L.  by  her  first  husband  had  2  girlslo  boys  by 
,,  ,,  second     ,,  ,,    4     ,,   J     either. 

Mrs.  S.  A.  by  her  first  husband  had  2  girlst  o  boys  by 
second     ,,  ,,     3     »0     ^i^^er. 

Mrs.  P.  J.  by  her  first  husband  had  5  girls |o  boys  by 
,,  „  second     „  ,,     igirl  )     either. 


DOES  THE  FATHER  INFLUENCE  THE  SEX  ?     59 

Mrs.  R.  L.  by  her  first  husband  had  i  girl  ]  o  boys  by 
,,  ,,  second     „  ,,3  girls j     either. 

Mrs.  P.  B.  by  her  first  husband  had  2  girls]  o  boys  by 
„  ,,  second    ,,  „    ^    ,,   J     either. 

Mrs.  Mk.  by  her  first  husband  had  4  boyslo  girls  by 

second     „  „    3     ,,    )      either. 

Mrs.   S.   by  her  first  husband  had  3  boyslo   girls   by 

second     „  ,,3     „    J      either. 

Mrs.L.T.H.  by  her  first  husband  had  2  boyslo  girls  by 

„  ,,  second     „  ,,    i  boy  J      either. 

Mrs.  L.  D.  by  her  first  husband  had  4  boys)  o  girls  by 

,,  ,,  second    „  „    i  boy  J      either. 

Mrs.  W.  by  her  first  husband  had  2   boys|o  girls  by 

„  „  second    ,,  „    i  boy  )      either. 

Surely  if  the  husbands  settled  the  sex,  the  above  mothers 
would  have  had  mixed  children,  instead  of  only  one-sexed 
children  by  two  different  men;  the  wives  were  unilaterally 
sterile.  These  cases  show  that  the  spermatozoa  of  two 
different  men  were  quite  unable  to  produce  both  sexes  in 
certain  women,  so  that  sex  determination  does  not  lie  in 
the  spermatozoa. 

In  the  following  cases  the  husband  of  more  than  one  wife 
gets  one-sexed  children  only  from  each  wife ;  but  as  they  differ 
in  the  different  wives,  while  the  sexual  act  is  the  same  for 
each  wife,  the  inference  must  be  that  the  wife  settles  the  sex. 

Mr.  G.  Y.  by  his  first  wife  had  3  girls,  o  boys. 
,,  ,,         second      ,,       3  boys,  0  girls. 

,,  ,,         third        ,,       I  boy,  o  girls. 

Mr.  L.  by  his  first  wife  had  3  boys,  o  girls;  then  he  married 
a  widow  who  already  had  one  girl  hy  her  first  husband ;  by 
the  widow,  his  second  wife,  L.  had  3  girls,  o  boys. 

Mr.  P.  by  his  first  wife  had    3  boys,  o  girls. 

,,  ,,  second  ,,  5  girls,  o  boys. 
Mr.  S.  by  his  first  wife  had    7  boys,  o  girls. 

,,  ,,  second  ,,  i  girl,  o  boys. 
Mr.  H.  B.  by  his  first  wife  had  3  boys,  o  girls. 

„         ,,      second      ,,        4  girls,  o  boys. 


6o  THE  CAUSATION  OF  SEX 

In  the  above  cases  the  fathers  produced  both-sexed 
children  with  different  wives,  but  only  one  sex  with  each 
wife, — i.e.  the  father  did  not  influence  the  sex;  the  women 
were  "  unilaterally  "  sterile. 

In  the  following  cases  the  man  gets  both-sexed  children 
with  one  of  his  wives,  but  only  one  sex  with  the  other, 
because  she  is  "  unilaterally  "  sterile;  if  it  depended  on  the 
male  he  should  get  both-sexed  children  with  both  wives. 

Mr.  Mil.  by  his  first  wife  had  four  girls,  no  boys;  by  his 
second  wife  had  first,  a  girl;  second,  a  boy;  third,  a  girl. 

Mr.   P.   by  his  first  wife  had  5  boys,  o  girls. 

,,         ,,         second     ,,         i  boy,  9  girls. 
Mr.   C.  by  his  first  wife  had  2  boys,  7  girls. 

,,         ,,         second      ,,         4  boys,  o  girls. 
Mr.  P.  T.  by  his  first  wife  had  3  girls,  0  boys. 

,,         ,,        second       ,,        first  i  boy,  then  i  girl. 
Mr.  K.  by  his   first  wife  had     2  boys,  i  girl. 

,,         ,,        second      ,,         2  girls,  o  boys. 
Mr.  T.  F.  by  his  first  wife  had  5  girls,  o  boys. 

,,         ,,       second       ,,  2  girls,  i  boy. 

MoNORCHiDS. — In  those  cases  where  men  have  only  one 
testicle — monorchids,  as  they  are  called — we  should  expect, 
unless  we  assumed  that  both  testicles  contain  spermatozoa 
able  to  determine  both  sexes,  that,  if  the  male  settled  the 
sex,  all  the  children  he  had  would  be  of  one  sex  only,  and 
would  correspond  in  sex  to  the  testicle  he  possessed;  but 
this  is  not  so,  and  the  following  cases  practically  prove  it: 

C.  W.,  examined  by  me,  has  no  sign  of  a  right  testicle 
or  cord;  he  has  the  left  testicle  only.  His  wife  has  had  3 
children  by  him:  2  boys,  i  girl. 

/.  F.,  examined  by  me,  has  the  right  testicle  only  ;  there  is 
not,  and  never  has  been,  any  sign  or  sensation  of  a  left  one. 
His  wife  has  had  4  children  by  him  (2  boys,  2  girls)  thus: 
(i)  Boy,  (2)  girl,  (3)  girl,  (4)  boy. 

H.  P.,  a  medical  man,  has  the  right  testicle  only  ;  never 
had  any  sign,  he  says,  of  a  left  one,  being  born  with  the 
one  only.  His  wife  has  had  3  children  by  him :  first  a  boy, 
then  2  girls. 


DOES  THE  FATHER  INFLUENCE  THE  SEX  ?      6i 

The  above  three  very  typical  and  interesting  cases  show 
that  a  man  with  one  testicle  only  can  give  rise  to  the  birth 
of  either-sexed  children;  also  that  the  spermatozoa  from 
each  testicle  have  not  their  own  particular,  definite  sex, 
according  to  which  testicle  they  arise  from — they  are, 
indeed,  asexual  or  sexless. 

The  cases  quite  disprove  the  Hippocratic  idea  that 
spermatozoa  from  one  testis  can  only  fertilise  the  ova  from 
the  ovary  of  the  corresponding,  or  even  the  opposite,  side. 

The  spermatozoa  from  either  testicle  are  thus  proved 
able  to  fertilise  the  ova  from  either  ovary,  or  even  both 
ovaries,  and  so  give  rise  to  either-sexed  children — in  fact, 
a  monorchid  can  be  father  of  boy  and  girl  twins.  This 
fertilising  of  an  ovum  is  quite  different  to  initiating  its 
sex,  or  "  sexifying  "it. 

That  the  male  parent  or  father  has  nothing  to  do  with 
the  causation  of  sex  is  borne  out  by  animals  also:  I  have 
noticed  that  in  them  a  certain  female  will  give  with  different 
males  all  the  same  sex  of  offspring. 

Knight,  quoted  by  W.  B.  Carpenter^  as  long  ago  as  1809, 
remarked  that: 

"  In  flocks  or  herds  of  domesticated  quadrupeds,  it  is  no  un- 
common thing  to  meet  with  females,  whose  offspring  is  almost  in- 
variably of  the  same  sex,  although  it  have  resulted  from  intercourse 
with  several  different  males;  on  the  other  hand,  he  has  never  met 
with  males  that  exhibited  any  such  uniformity  in  the  sex  of  their 
offspring  with  different  females.  Hence  he  concluded  that  the 
female  parent  exercises  the  chief  influence  in  determining  the  sex." 

In  support  of  the  truth  of  this  statement  the  following 
cases  in  my  own  experience  will  suffice : 

A  brown  retriever  bitch  known  as  "  Brownie  "  had  four 
pups,  all  bitches — no  dog  pups. 

A  black-and-tan  bitch  was  covered  by  two  different  stud 
dogs  at  different  times;  at  the 

First  litter  she  had  2  dogS)        , -^  1 
Second  A  ^^  ^^^""^  P^P^- 

that  is,   two   different   fathers   could  not   produce   female 

^  "  Principles  of  General  and  Comparative  Physiology,"  1841,  p.  500. 


62  THE  CAUSATION  OF  SEX 

offspring.  Both  these  stud  dogs  the  writer  knows  possessed 
both  testicles.  I  mention  this  because  many  owners  remove 
one  testicle  from  dogs,  fox-terriers  especially,  and  this  does 
not  cause  one  sex  pups  only  to  be  born  to  any  bitch  they 
may  line.  It  has  been  proved,  too,  that  a  unilaterally 
castrated  bull  similarly  produces  calves  of  both  sexes. 
Hence  the  male  animal  does  not  determine  the  sex. 

A  cow  was  covered  by  fifteen  different  bulls,  and  she  had 
seventeen  calves,  all  cow  or  female  calves — that  is,  fifteen 
different  fathers  could  not  breed  a  male  between  them. 
Surely  if  the  male  parent  influenced  the  sex,  we  should 
have  expected  fifteen  different  males  to  be  able  to  breed  a 
bull  between  them. 

A  mare  was  covered  by  more  than  six  different  stallions 
(some  being  used  more  than  once).  She  had  ten  different 
foals,  all  males — that  is,  she  never  once  had  a  filly  or  female 
foal.  The  multiple  fathers  could  not  affect  the  sex  of  the 
foals.  The  mother  evidently  was  unilaterally  sterile,  only 
the  right  ovary  being  active.  And  in  the  same  way  the 
bitch  and  cow  must  have  been  unilaterally  sterile,  so  that 
the  multiple  fathers  could  only  produce  one  sex. 

And  lastly,  from  the  "  Daily  Mail  "  I  read: 

"  A  sow  belonging  to  Mr.  A.  Watson,  of  the  Grange  Farm,  Claver- 
ing,  has  given  birth  to  a  litter  of  ten,  all  of  which  are  boar  pigs." 


CHAPTER  VIII 

CASES   OF  PREGNANCY  WHICH    PROVE 
THE   THEORY 

In  order  to  prove  my  theory  that  the  cause  of  the  male  sex 
is  due  to  the  fertiUsation  of  ova  derived  from  the  right  ovary 
only,  it  will  be  necessary  to  show  cases  of  male  pregnancy 
with  the  corpus  luteum  in  the  right  ovary. 

We  have  seen  that  normally  one  ovary  discharges  a  single 
ovum,  and  this  when  fertilised  leads  to  the  normal  single 
pregnancy ;  if  on  examining  a  child  we  find  it  to  be  a  male, 
and  the  right  ovary  to  contain  a  well-marked  true  corpus 
luteum,  we  are  justified  in  saying  that  the  ovum  from  that 
right  ovary  produced  a  male  foetus.  This  I  find  to  be 
always  so,  and  the  following  cases  will  prove  it. 

Jemima  H.,  age  40,  four  months  pregnant.  Admitted 
an  in-patient  at  Westminster  Hospital  for  stiff  knee-joint. 

She  suddenly  developed  acute  suppurative  peritonitis, 
which  led  to  her  aborting.  The  foetus  was  removed  shortly 
before  her  death,  which  occurred  on  November  30th,  1889. 

On  examination  the  foetus  was  found  to  be  a  male.^  Post 
mortem  the  left  ovary  was  normal,  the  right  slightly  en- 
larged, and  containing  a  well-marked  corpus  luteum. 

TufnelVs  ^  case. 

"  The  patient  had  seven  years  before  given  birth  to  a  living  child. 
Again  pregnant.   .   .   . 

"  Post  mortem  three  or  four  quarts  of  fluid  and  clotted  blood  were 
found  in  the  abdomen,  with  a  small  foetus  floating  therein.  There 
was  a  rent  in  the  right  Fallopian  tube,  and  a  cyst,  from  which  the 
foetus  had  escaped.  Right  Fallopian  tube  and  ovary  agglutinated: 
foetus  one  inch  long.  The  uterus  contained  a  healthy  male  foetus, 
proportionate  to  the  date  of  conception.     The  cystic  cavity  in  the 

1  By  Drs.  J.  B.  Potter.  R.  G.  Hebb,  and  E.  Rumley  Dawson. 

-  Tufnell,  "New  Sydenham  Society's  Year  Book,"  1862,  p.  339. 

63 


^4  THE  CAUSATION  OF  SEX 

right  Fallopian  tube  contained  a  solid  organised  mass  like  a  miniature' 
placenta.     There  were  two  distinct  corpora  lutea  in  the  right  ovary." 

We  have  here  two  foetuses  and  tw©  corpora  Ihatea  in  the 
san«e  ovary,  the  right ;  the  sex  (male)  i&  only  given  of  the 
intra-uterine  foetus.  It  is  a  twin  male  conception  un- 
doubtedly, the  second  foetus  developed  in  the  right  tube, 
and  must  have  been  ai  male.     Cf.  Chapter  IX. 

Dr.  H.  R.  Spencer's^  three  cases  of  Porro's  operation. — 
Dr.  H.  R.  Spencer  removed  the  pregnant  uterus  owing  to 
cancer  obstructing  delivery  in  the  third  case. 

"  The  child  extracted  was  a  boy,  and  there  was  a  well-marked 
corpus  luteum  in  the  right  ovary." 

Mrs.  P.,  of  Leyton,  was  delivered  of  a  boy,  who  survives. 
The  patient  died  of  puerperal  septicaemia.  At  the  post- 
mortem, at  which  I  was  present,  there  was  a  well-marked 
corpus  luteum  in  the  right  ovary,  none  in  the  left.  Placental 
site  was  rather  more  to  the  right  than  to  the  left  of  the 
mid-line  of  the  anterior  wall  of  uterus. 

Dr.  Macnaughton-Jones  ^  describes  a  case  of  first  preg- 
nancy in  a  woman  the  subject  of  a  large  suppurating  cyst 
of  the  left  ovary,  which  had  become  so  large  as  to  increase 
the  size  of  her  abdomen  a  year  previously  to  her  becoming 
pregnant. 

"The  patient,  aged  31,  was  delivered  of  a  healthy  male  child. 
On  operating,  the  tumour  was  found  to  be  a  cystoma  of  the  left 
ovary,  from  which  an  enormous  quantity  of  pus  was  evacuated. 
The  right  ovary  I  examined,  and  found  normal." 

Here  it  is  evident  that  a  large  suppurating  cyst  of  the  left 
ovary  did  not  provide  the  ovum  which  was  fertilised,  but 
the  right  ovary  must  have  done  so.  As  this  was  healthy,  it 
was  not  opened  at  the  operation,  so  the  presence  of  the 
corpus  luteum  therein  must  be  inferred.  The  child  born 
was  a  boy,  and  the  right  ovary  only  was  healthy. 

Meredith's^  case. — Both  ovaries  diseased,  right  the  least. 
Child  a  male.  Performed  double  ovariotomy  during 
pregnancy. 

1  H.  R.  Spencer,  "  Trans.  Obstet.  Soc,"  1896. 

~  Macnaughton-Jones,  "Trans.  Obstet.  Soc,"  1900,  p.  141. 

^  W.  A.  Meredith,  "  Trans.  Obstet.  Soc,"  1892,  p.  240,  etc. 


PREGNANCIES  WHICH  PROVE  THE  THEORY    65 

"  The  larger  tumour  of  the  two  was  extremely  multilocular.  The 
right  ovary,  situated  anterior  to  the  main  or  larger  tumour,  con- 
tained one  main  cavity,  etc." 

"  Subsequently  the  pregnancy  terminated  in  the  birth  of  a  well- 
developed  boy." 

It  is  only  reasonable  to  expect  that  the  ovary  that  was 
only  sHghtly  affected  should  have  yielded  the  ovum.  It 
was  the  right  ovary  that  had  the  smaller  tumour,  and  the 
resulting  child  was  a  boy. 

On  the  other  hand,  I  find  that  the  female  sex  is  due  to 
ova  which  arise  from  the  left  ovary  only:  to  prove  it  it  is 
necessary  to  give  cases  of  female  pregnancy  with  the  corpus 
luteum  in  the  left  ovary,  thus: — 

Dr.  Amand  Routh,^  in  a  case  of  "  Uterine  appendages 
showing  Haematosalpinx,"  says: 

"  These  bilateral  appendages  were  removed.  The  uterus  was 
enlarged,  and  this  condition,  with  the  dilated  tube  and  the  corpus 
luteum,  was  taken  to  mean  that  an  early  tubal  gestation  was  present, 
especially  as  the  corpus  luteum  was  on  the  same  side  as  the  tubal 
swelling." 

Subsequently  the  patient  was  found  to  be  pregnant  five 
months — 

"  So  that  at  the  date  of  the  removal  of  the  appendages  she  must 
have  been  two  and  a  half  months  pregnant.  Her  labour  was  un- 
eventful.    Her  child  was  small." 

Dr.  Routh  now  informs  me  that  the  corpus  luteum  was 
in  the  left  ovary;  the  child  when  subsequently  born  was 
a  girl. 

Dr.  Herman's  ^  case. — Disease  of  right  ovary.  Child 
female.     No  corpus  luteum  mentioned. 

"  On  the  right  side  a  cheesy-matter-containing  body  was  attached 
to  the  right  broad  ligament :  examined  microscopically  it  was 
thought  to  be  the  ovary.     The  foetus  was  a  female." 

The  right  ovary  being  disintegrated  and  diseased,  the 
left  ovary  must  have  supplied  the  ovum,  and  the  child  was 
consequently  a  female. 

1  Amand  Routh,  "  Trans.  Obstet.  Soc,"  1898,  p.  307. 

2  Herman,  "  Trans.  Obstet.  Soc,"  1897,  pp.  135-7. 

5 


66  THE  CAUSATION  OF  SEX 

Dr.  H.  R.  Spencer's^  three  cases  of  Porro's  operation. — 
Dr.  H.  R.  Spencer  removed  the  pregnant  uterus  owing  to 
fibroids  in  the  first  case.  The  child  was  a  female,  and 
though  the  corpus  luteum  is  not  mentioned,  it  is  distinctly 
stated  that  the  left  ovary  was  larger  than  the  right. 

The  presence  of  a  true  corpus  luteum  invariably  tempo- 
rarily increases  the  size  of  the  ovary  in  which  it  is  contained, 
until  it  shrinks  and  disappears;  so  that  in  this  case  it  is 
reasonable  to  conclude  that  the  larger  size  of  the  left,  or 
normally  smaller  ovary,  was  due  to  the  presence  therein  of 
the  corpus  luteum  of  the  pregnancy. 

Gerrish  ^  says : 

' '  During  pregnancy  the  gland  (ovary)  which  contains  the  corpus 
luteum  is  much  larger  than  its  fellow." 

And  the  difference  in  the  size  of  the  two  ovaries  caused 
by  the  presence  or  absence  of  the  corpus  luteum  was  strongly 
insisted  on  by  Montgomery  in  1837,  in  his  book  "  Signs  and 
Symptoms  of  Pregnancy,"  in  which,  besides  giving  a  special 
plate,  No.  X.,  of  such  ovaries,  he  gives  on  p.  221  measure- 
ments to  prove  it. 

1  H.  R.  Spencer,  "  Trans.  Obstet.  Soc,"  1896,  pp.  397  and  399. 

2  Gerrish,  op.  cit.,  p.  849. 


CHAPTER  IX 

CASES  OF    EXTRA-UTERINE   PREGNANCY 
WHICH    PROVE   THE   THEORY 

Extra-uterine  pregnancy  is  the  technical  term  for  cases 
where  a  child  develops  in  the  wrong  place— /.^.  outside  the 
uterus  or  womb. 

The  commonest  position  for  the  child  to  grow  in,  outside 
of  the  womb,  is  in  one  or  other  Fallopian  tube,  hence  these 
cases  are  called  tubal  pregnancies.  In  a  few  instances  it 
actually  grows  in  the  ovarian  sac  or  Graafian  follicle  which 
contained  the  ovum,  hence  this  is  called  ovarian  pregnancy. 

In  the  very  great  majority  of  cases  of  tubal  pregnancy, 
the  tube  which  becomes  pregnant  is  the  one  on  the  same 
side  of  the  uterus  as  the  ovary  which  supplies  the  ovum  which 
becomes  fertilised — i.e.  in  the  tube  nearest  the  ovary. 

The  following  cases  will  prove  that  the  pregnancy  and  the 
corpus-luteum-bearing  ovary  are  usually  on  the  same  side. 

Dr.  Pocock's  case.^ — Pregnancy  in  right  tube;  corpus  in 
right  ovary.     Case  of  extra-uterine  gestation. 

"  The  fa3tus  had  escaped  from  the  ruptured  sac  formed  at  or  near 
the  fimbriated  extremity  of  the  right  Fallopian  tube,  where  the 
placenta  was  placed.  There  was  a  well-marked  corpus  luteum 
in  the  right  ovary.     The  foetus  was  about  three  months." 

No  sex  is  given,  and  though  I  wrote  privately  for  it  I 
could  not  discover  it. 

E.  Rumley  Dawson  s  case.^ — Pregnancy  in  right  tube; 
corpus  in  right  ovary.  The  right  Fallopian  tube  had  con- 
tained the  fertilised  ovum. 

"  The  right  Fallopian  tube  had  ruptured.  The  right  ovary  con- 
tained a  corpus  luteum." 

The  embryo  was  too  young  to  distinguish  its  sex. 

1  "  Lancet,"  March  3,  1888,  p.  416. 

2  "  Trans.  Obstet.  Soc,"  1898.  p.  156. 

67 


68  THE  CAUSATION  OF  SEX 

Dr.  W.  Duncan^  describes  and  has  a  drawing  of  a  case 
of  tubal  gestation. 

"  The  right  tube  had  ruptured.  The  right  ovary  contained  a  large 
corpus  luteum." 

Dr.  Lewers^  describes  a  case  of  right  tubal  pregnancy: 

"  There  was  a  large  corpus  luteum  in  the  right  ovary;  no  corpus 
uteum  in  the  left  ovary  "  ; 

and  again,  p.  364: 

"Left  tubal  (interstitial)  pregnancy;  corpus  luteum  in  the  left 
ovary." 

Dr.  Cullingworth^  :  also  a  right  tubal  pregnancy. 

"  The  right  ovary  contained  a  corpus  luteum  \  in.  in  diameter. 
Left  tube  and  ovary  were  normal." 

Dr.  Amand-Routh^ : 

"  Pregnancy  in  left  tube;  corpus  luteum  in  left  ovary.  The  right 
tube  was  normal;  a  nodule  could  be  felt  on  the  left  tube." 

The  report  on  the  specimen  by  Mr.  J.  H.  Targett  says: 

"  The  specimen  consists  of  the  (left)  Fallopian  tube,  ovary,  and 
adjacent  portion  of  the  broad  ligament.  The  ovary  contains  a 
recent  corpus  luteum.  The  Fallopian  tube  is  dilated  with  an  oval 
cyst.     The  histological  evidence  of  gestation  is  thus  assured." 

B.  Dyball  ^  reports : 

"  Left  tubal  pregnancy,  and  the  left  ovary  contained  a  corpus 
luteum  of  pregnancy  ^  in.  in  diameter." 

Sir  J.  Bland-Sutton  has  diagrams  illustrating  the  corpus 
luteum  on  the  same  side  as  the  tubal  pregnancy  in  his 
"Diseases  of  Ovaries,"  1896,  Figs.  105,  108,  115;  and 
Fig.  95  in  "  Diseases  of  Women,"  1904. 

This  is  still  further  proved  by  cases  of  repeated  tubal 
pregnancy;  thus: 

1  "  Trans.  Obstet.  Soc,"  1894,  p.  68;  cj.  also  1896,  p.  36 — a  similar  case. 

2  "  Diseases  of  Women,"  1897,  p.  375. 

3  "  Trans.  Obstet.  Soc,"  1895,  p.  143. 

4  Ibid.,  1898,  p.  222. 

s  B.  Dyball,  "  Case  of  Tubal  Gestation,"  "  Brit.  Med.  Journ.,"  March  26, 
1904,  p.  718. 


PROOFS  BY  EXTRA-UTERINE  PREGNANCY     69 

Dr.  Lewers^  describes  a  case  where  he  removed  the  left 
pregnant  tube  and  the  left  ovary,  which  contained  the  corpus 
luteum,  in  1894;  becoming  pregnant  again  in  the  remaining, 
or  right  tube,  that  too  was  removed  in  May  1900,  the 
accompanying  right  ovary  necessarily  containing  the  corpus 
luteum.  I 

In  the  "  Journal  of  Obstetrics  and  Gynaecology  of  the 
British  Empire,"  vol.  iv.  p.  301,  I  have  reported  a  very 
similar  case,  the  left  ovary  containing  the  corpus  luteum 
when  the  left  tube  was  pregnant,  and  the  right  ovary  neces- 
sarily doing  so  when  the  right  tube  became  pregnant  two 
years  later,  for  the  appendages  of  the  opposite  side  had  been 
removed. 

And  similarly  Lieut. -Col.  A.  J.  Sturmer,  in  the  same 
volume  (p.  139),  has  reported  two  such  cases,  the  corpus 
luteum  being  on  the  same  side  as  the  pregnant  tube  in  each  case. 

Opitz,^  quoted  by  Dr.  Russell  Andrews,  "  found  the 
corpus  luteum  on  the  same  side  as  the  pregnant  tube  in 
fifteen  out  of  eighteen  cases." 

The  above  cases,  then,  should  suffice  to  prove  that  the 
pregnant  tube  and  the  corpus  luteum-bearing  ovary  are 
usually  on  the  same  side;  but  cases  might  be  indefinitely 
multiplied. 

From  this  fact  it  follows  that  if  we  find  a  pregnancy  in 
the  right  Fallopian  tube,  and  that  foetus  is  a  male,  even 
though  the  presence  of  a  corpus  luteum  be  not  mentioned, 
we  are  quite  justified  in  declaring  the  ovum  came  from 
the  right  ovary,  or  ovary  of  the  corresponding  side  to  the 
tube. 

The  following  cases  of  this  therefore  support  my  theory 
that  ova  from  the  right  ovary  produce  male  children. 

Taylor's  case.^ — Abdominal  pregnancy.  Right  tube,  male 
child. 

"  The  pregnancy  may  be  regarded  as  originally  one  of  the  right 
Fallopian  tube.     The  child  weighs  7  lb.,  and  is  a  male  foetus." 

"It  was  impossible  to  say  whether  the  right  ovary  had  been 
removed  with  the  placenta,  or  whether  it  had  been  left  in  the  pelvis 
below  the  reflections  of  the  sac." 

1  "  Trans.  Obstet.  Soc,"  1900,  p.  325. 

2  "  Journal  of  Obstetrics  and  Gynaecology,"  vol.  iv.  p.  290. 

3  J.  W.  Taylor,  "  Trans.  Obstet.  Soc,"  1897,  pp.  183-5. 


70  THE  CAUSATION  OF  SEX 

Dr.  Cullingworth's  case.-^ — Sac  on  right  side;  male  child. 

"  The  sac  containing  the  foetus  consisted  of  the  right  hroad  Uga- 
ment.  The  stretched  Fallopian  tube  ran  diagonally  upwards  and 
outwards,  and  then  ceased  to  be  traceable  as  a  distinct  tube. 

"  The  foetus  was  one  of  the  male  sex." 

Sir  J.  Bland -Sutton's  case.^'^ — Right  tubal  pregnancy. 
Drawing  shows  sex  male,  and  (?)  corpus  luteum  in  right 
ovary. 

"  Fluid  blood  has  escaped  from  a  rent  in  the  right  broad  ligament. 
The  Fallopian  tube  on  that  side  was  enlarged,  and  was  removed 
with  the  ovary.  The  embryo  appears  to  have  lodged  in  the  right 
Fallopian  tube." 

The  drawing  which  accompanies  the  case  shows  the  foetus 
to  be  a  male,  and  what  is  possibly  the  corpus  luteum  in  the 
right  ovary,  for  the  left  was  not  removed. 

In  the  following  case  in  the  practice  of  one  of  my  colleagues 
the  patient  was  thought  to  have  inflammation  of  the  right 
ovary.  She  died  from  haemorrhage  internally  rather 
suddenly  on  March  i8,  1899. 

At  the  postmortem  which  was  ordered  I  found  that  the  left  Fallopian 
tube  and  left  ovary  were  normal,  and  there  was  no  corpus  luteum 
in  it.  The  gestation  sac  was  formed  from  the  right  Fallopian  tube, 
which  had  burst  between  the  layers  of  the  right  broad  ligament. 
There  the  child  (a  boy)  continued  to  develop  for  nearly  three  months 
longer,  when  a  second  ruptiire  into  the  peritoneal  cavity  took  place, 
killing  the  patient  by  the  extent  of  the  haemorrhage.  The  right 
ovary  and  corpus  luteum  could  not  be  found.  The  child  (a  male) 
had  developed  in  the  right  Fallopian  tube,  and  the  left  ovary  did 
not  contain  a  corpus  luteum ;  so  we  know  the  right  ovary  had  originally 
provided  the  ovum. 

In  the  following  case  the  child  (a  boy)  had  originally 
begun  to  develop  in  the  right  Fallopian  tube,  from  which 
it  passed  to  finish  its  development  in  the  abdominal  cavity, 
forming  the  so-called  tubo-abdominal  form  of  pregnancy. 
The  afterbirth  or  placenta  continued  to  chiefly  develop  in 
the  right  tube.  There  is  no  account  of  the  corpus  luteum, 
as  the  right  ovary  would  probably  be  destroyed  in  the  growth 
of  the  child  and  its  placenta. 

1  C.  J.  Cullingworth,  "  Trans.  Obstet.  Soc."  1893,  pp.  157,  159. 

2  J.  Bland-Sutton.  Ibid.,  1891,  pp.  71.  72. 


PROOFS  BY  EXTRA-UTERINE  PREGNANCY     71 

/.  B.  Hellier^  says: 

"  A  dead  foetus  was  removed  by  abdominal  section  from  the 
peritoneal  cavity,  together  with  a  tumour  which  arose  from  the 
right  oviduct,  and  contained  the  placenta.  It  was  then  found  that 
the  right  foot  was  attached  to  a  pelvic  tumour  which  lay  in  the  utero- 
vesical  pouch  and  on  the  right  side.  The  foetus  is  a  male.  The 
placenta  is  contained  within  a  sac  .  .  .  made  up  partly  of  the 
ampullar  end  of  the  tube." 

Dr.  M.  Abdul-Hamid,  medical  officer  to  Kalioub  Hospital, 
Egypt,  has  reported  a  similar  case.  The  pregnancy  was 
in  the  right  tube,  which  ruptured  into  the  abdominal 
cavity,  whence  Dr.  Hamid  removed  the  male  foetus  two 
months  after  full  term  by  abdominal  section. 

Slamjer^  in  1901  reported  a  case  where  the  foetus  was  a 
male,  and  had  developed  in  the  right  broad  ligament  a  right 
mesometric  gestation. 

In  the  "  Medico-Chirurgical  Review  and  Journal,"  vol.  x., 
1828,  p.  223,  is  the  case  of  Mrs.  E.  Bryan,  who  died  as  the 
result  of  an  extra-uterine  gestation.  The  child  was  "  a 
full-grown  male  infant."  It  had  developed  in  the  right 
Fallopian  tube  originally,  and  had  then,  after  rupture, 
continued  to  grow  between  the  layers  of  the  right  broad 
ligament — a  right  mesometric  gestation. 

"  The  left  ovarium  and  corresponding* Fallopian  tube  are  sound." 

In  the  same  journal  (vol.  v.,  1826,  pp.  618,  619)  is  another 
case.  Post  morten  a  male  foetus  was  found  to  have  escaped 
by  rupture  from  a  cyst  on  the  right-hand  side  of  the  uterus, 
which  had  arisen  from  the  right  ovary. 

Dr.  Russell  Andrews^  has  reported  a  case  of  twin  preg- 
nancy in  the  right  Fallopian  tube.  Both  children  were 
males. 

In  the  same  manner,  pregnancy  in  the  left  tube  practically 
always  means  a  left  ovulation;  so  that  finding  a  female 
foetus  in  the  left  Fallopian  tube,  even  in  the  absence  of 
mention  of  a  corpus  luteum  being  present  in  the  left  ovary, 
may  be  taken  as  proof  that  the  left  ovary  provided  the  ovum 

^  Hellier,  "  Trans.  Obstet.  Soc,"  vol.  xlv.  1903,  p.  366. 

2  "  Brit.  Med.  Journ.,"  Epitome. 

^  "  Trans.  Roy.  Soc.  of  Med.,"  vol.  ii.  1909,  p.  228, 


72  THE  CAUSATION  OF  SEX 

that  was  fertilised,  and  hence  gives  support  to  my  theory; 
thus: 

Sir  Jonathan  Hutchinson's  case.-"^ — Left  tubal  gestation. 
Child  female.     Corpus  luteum  not  mentioned. 

"  At  the  post-mortem  examination  we  found  the  tumour  adherent 
everywhere  to  the  abdominal  wall  and  omentum.  On  cutting  into 
the  cyst  the  body  of  a  macerated  foetus  was  found.  It  was  a  female, 
and  at  full  term.  On  further  dissection  of  the  parts  the  case  proved 
to  be  one  of  gestation  in  the  left  Fallopian  tube.  The  left  Fallopian 
tube  could  be  traced  for  a  short  distance  on  the  front  of  the  cyst. 
The  left  broad  ligament  passed  downwards  from  the  front  of  the 
cyst,  and  between  its  extremity  and  that  of  the  Fallopian  tube  was 
a  thickened  mass,  which  might  perhaps  be  the  remains  of  the  ovary, 
but  it  was  not  practicable  accurately  to  identify  it." 

Dr.  Cullingworth's  case.^ — Left  tube;  child  female.  No 
corpus  luteum  given. 

"  On  August  1 6,  at  St.  Thomas's  Hospital,  Dr.  Cullingworth 
removed  a  foetus  weighing  2  lb.  13  oz.,  and  measuring  17  in.  in  length, 
through  an  incision  in  the  anterior  abdominal  wall.  The  sac  in 
which  this  was  contained  was  very  thin,  and  formed  by  the  greatly 
dilated  left  Fallopian  tube.  The  duration  of  the  pregnancy  was 
sixteen  months ;  the  foetus  was  well  preserved,  and  had  the  appear- 
ance of  fully  eight  months'  development." 

On  writing  to  Dr.  Cullingworth  to  ascertain  the  sex,  he 
says  (September  i,  1888):  "  The  child  was  a  female." 

Lawson  Tail  ^  quotes  a  case  by  Dr.  Wagner.  Left  tube 
and  ovary  implicated.     Child  female. 

"  The  patient  up  to  the  age  of  twenty-four  had  given  birth  to 
five  children ;  in  her  thirty-seventh  year  she  again  became  pregnant, 
but  was  never  delivered  of  the  child.  Labour  pains  were  not  present. 
For  a  long  time  the  abdominal  enlargement  remained  constant  in 
size,  and  Caesarean  section  was  advised.  Finally  the  tumour  began 
to  grow  smaller.  Her  menses  returned,  and  fair  health  was  ex- 
perienced, the  only  complaint  being  a  feeling  of  weight  in  the  abdo- 
men. At  the  autopsy  the  tumour  was  found  to  fill  the  lower  pelvis. 
The  tumour  weighed  about  |  lb.,  and  was  about  the  size  of  a  man's 
head.  It  was  covered  by  a  yellowish  membrane.  The  left  tube 
and  ovary  seemed  to  be  growing  from  the  tumour,  the  uterus  being 
pushed  from  the  right.     The  foetus  was  of  female  sex." 

1  "  Case  of  Extra-uterine  Fcetation  simulating  Ovarian  Dropsy," 
"  Lancet,"  July  19,  1873,  p.  71,  by  Sir  J.  Hutchinson,  F.R.C  S. 

2  "  Lancet,"  August  25,  1888,  p.  391. 

^  "  Lectures  on  Ectopic  Pregnancy  and  Pelvic  Haematocele, "  p.  102, 
1888. 


PROOFS  BY  EXTRA-UTERINE  PREGNANCY     73 

Dr.  Ruth  reports  a  case  in  the  "  Medico-Chirurgical 
Review  and  Journal,"  July  1825,  P-  285,  of  the  removal 
of  a  dead  extra-uterine  foetus  from  the  abdominal  cavity. 
It  had  evidently  been  a  left  tubo-abdominal  gestation : 

"  The  umbilical  cord  was  traced  over  the  uterus  to  the  left  side, 
where  it  was  lost  in  a  softened  mass,  probably  the  remains  of  the 
placenta.     The  child  was  found  to  be  a  female." 

Dr.  A.  Smith^  describes  a  somewhat  similar  case— a  left 
tubo-abdominal  pregnancy.  "  The  placenta  was  attached 
to  the  brim  of  the  pelvis  on  the  left  side."  The  main  blood 
supply  came  from  the  left  ovarian  artery.  The  left  tube 
and  ovary  were  destroyed  by  the  growth  of  the  child, 
which  was  a  full-time  female. 

Dr.  Lionel  Stretton^  reported  the  removal  of  a  dead 
female  foetus  from  the  left  broad  ligament.  It  had  been 
retained  many  years. 

In  the  two  following  cases  we  have  twin  pregnancies,  one 
in  the  uterine  cavity,  the  other  extra-uterine,  that  is,  in 
one  or  other  Fallopian  tube.  As  we  have  already  seen, 
the  pregnant  tube  almost  invariably  obtains  its  oosperm 
from  the  ovary  of  the  same  side;  and  as  twins  or  even 
triplets  can  occur  in  one  tube,  it  is  reasonable  to  claim 
that  the  uterine  child  was  derived  from  the  ovary  of  the 
opposite  side  to  the  pregnant  tube — thus  Warnek^  found  on 
operation  a  pregnant  left  tube,  while  the  uterus  gave  birth 
to  a  boy. 

So  that  this  male  had  been  derived  from  the  opposite 
ovary  to  the  left,  that  is  the  right. 

Mrs.  Stanley  Boyd"^  removed  a  pregnant  right  tube  (ovum 
evidently  derived  from  right  or  male  ovary),  and  the  uterus 
contained  a  female  child,  which  similarly  must  have  been 
derived  from  the  left  or  opposite  ovary. 

This  case  is  further  an  example  of  failure  to  remove  all 
ovarian  tissue,  owing  to  the  "  adhesions  to  the  pelvic  wall 
and  the  right  side  of  the  uterus  "  evidently  preventing  the 

^  Dr.  Alfred  Smith,  "  Brit.  Med.  Journ.,"  October  5,  1901,  p.  961. 
2  "  Lancet,"  March,  1909. 

^  Warnek,  "  Brit.  Med.  Journ.,"  Epitome,  January  25,  1902. 
*  "  Brit.  Med.  Journ.,"  October  5,  1901,  p.  962. 


74  THE  CAUSATION  OF  SEX 

entire  removal  of  all  ovarian  tissue,  probably  in  the  ovarian 
ligament,  though  there  are  other  possible  sites. 

It  is  of  course  evident  that  in  very  many  cases,  owing  to 
the  early  rupture  of  the  Fallopian  tube,  the  sex  of  the 
contained  foetus  cannot  be  ascertained. 

Dr.  Seligson,  of  Moscow,  has,  however,  collected  fourteen 
cases  of  males  developing  in  the  right  tube,  and  females 
in  the  left  tube. 

The  following  are  cases  of  pregnancy  occurring  in  the 
right  ovary  (right  ovarian  pregnancy) ;  the  sex  of  the  children 
was  male,  thus  supporting  my  theory. 

Bernutz  and  Goupil  ^ : 

"  A  woman,  aged  34,  had  had  three  children  prematurely,  and 
was  pregnant  the  fourth  time,  the  condition  being  accompanied 
by  extreme  prostration  and  a  good  deal  of  pain  on  the  right  of  the 
pelvis.  At  the  end  of  the  third  month  she  expelled  per  vaginam 
a  mole  the  size  of  an  egg  [the  uterine  decidua. — E.  R.  D.J.  Six 
days  after  this  she  experienced  most  agonising  pain  in  the  hypo- 
gastric region,  accompanied  by  severe  vomiting,  and  soon  after 
this  she  died. 

"  On  examination  a  male  foetus  was  found  in  the  right  iliac  fossa, 
but  still  attached  to  the  right  ovary  by  the  umbilical  cord.  The 
ovary  itself  was  ruptured  on  its  under  side.  The  organs  on  the  left 
side  were  healthy.  The  uterus  was  much  thickened,  and  large 
enough  to  admit  a  foetus  of  three  months ;  such  an  one  was  found  in 
the  abdomen." 

Bernutz  and  Goupil  ^ :  ^ 

"  A  lady  had  borne  eight  children  when,  after  an  interval  of  five 
years,  she  became  pregnant  for  the  ninth  time. 

"  At  the  third  month  she  became  very  weak,  had  colicky  pains, 
with  symptoms  of  approaching  labour,  and  died  in  nine  hours. 
On  opening  the  abdomen  a  large  quantity  of  blood  was  found 
effused,  and  in  removing  this  a  male  foetus  about  an  inch  long  was 
discovered. 

"  It  was  found  afterwards  that  the  right  ovary  was  ruptured  in  its 
length,  and  that  the  foetus  had  been  developed  therein." 

1  Bernutz  and  Goupil,  "  Diseases  of  Women,'"  vol.  i.  p.  249,  published  by 
New  Sydenham  Society,  1866,  quoted  from  "  Bibliothdque  medicale," 
vol.  xxxviii.  p.  265;  and  Dezeimeris,  "  Journal  des  connaissances  medico- 
chirurgicales, "  1837. 

2  Vol.  i.  pp.  249,  250.  Quoted  by  Bernutz  and  Goupil  from  "  Obser- 
vation deM.de  Saint  Moressy,  medecin  de  Riberac  en  Saintonge,"  1662 
(dans  Duverney,  "  (Euvres  anatomiques, "  Paris,  1761,  vol.  ii.  p.  350). 


PROOFS  BY  EXTRA-UTERINE  PREGNANCY     75 

The  following  is  a  case  of  pregnancy  in  the  left  ovary  (left 
ovarian  pregnancy) :  the  child  was  a  girl,  thus  proving  my 
theory  that  left-sided  ova  produce  female  children. 

Reeves'  case.^ — Left-s^ded  pregnancy;  child  female.  Right 
ovary  cirrhotic. 

"  On  opening  the  abdomen  a  large  tumour  was  exposed.  The 
shoulder  and  head  of  a  foetus  were  then  felt.  The  broad  ligament 
was  then  tied  close  to  the  uterus.  The  placenta  was  inside  the 
foetal  membranes,  which  were  enclosed  between  the  layers  of  the 
left  broad  ligament,  and  the  normal-looking  Fallopian  tube  was 
stretched  across  the  upper  and  anterior  aspect  of  the  tumour.  No 
trace  of  the  left  ovary  could  be  seen  or  felt,  and  in  peeling  off  the 
membranes,  which  were  firmly  adherent  in  places,  a  portion  of  the 
posterior  layer  of  the  broad  ligament,  corresponding  to  the  usual 
position  of  the  ovary,  was  removed  with  them. 

"  The  right  ovary  was  cirrhotic,  and  was  not  removed.  The  foetus, 
which  looked  like  a  full-termed  one,  was  a  female." 

Mr.  Reeves  says,  "  There  can  be  no  doubt  this  was  a 
genuine  case  of  true  ovarian  pregnancy." 

Whether  this  was  a  true  ovarian  pregnancy  or  not  is 
immaterial;  it  was  an  undoubted  left-sided  pregnancy,  with 
the  resulting  foetus  a  female. 

That  the  ovum  came  from  the  left  ovary  is  rendered  quite 
evident  by  the  fact  of  the  cirrhotic  condition  of  the  opposite 
or  right  ovary;  it  is  thus  a  very  convincing  case. 

^  H.  A.  Reeves,  F.R.C.S.Edin.,  "  Ectopic  Ovarian  Gestation,"  "  Lancet," 
October  25,  1890,  p.  872. 


CHAPTER  X 

CASES  OF  PREGNANCY  AFTER  OPERATIONS  ON 
THE  OVARIES,  WHICH  PROVE  THE  THEORY 
AND  SHOW  THE  EFFECT  ON  CHILDBEARING 
OF  OPERATIONS  ON  THE  OVARIES 

The  removal  by  a  surgical  operation  of  an  ovary,  usually 
on  account  of  a  tumour  therein,  is  known  as  ovariotomy; 
if  performed  on  one  side  only  it  is  known  as  unilateral 
ovariotomy,  or  more  definitely  as  right  or  left  ovariotomy, 
according  to  which  ovary  was  removed;  if  performed  on 
both  sides,  it  is  a  bilateral  or  double  ovariotomy. 

Unilateral  ovariotomy  does  not  prevent  a  woman  having 
children,  but  they  will,  I  maintain,  be  all  of  the  same  sex, 
provided  that  all  ovarian  tissue  is  removed  from  the  one 
side.  In  this  event  all  the  ova  must  necessarily  be  derived 
from  one  ovary  only,  viz.  from  the  ovary  on  the  opposite 
side  to  the  one  removed. 

If  therefore  the  left  ovary  is  completely  removed  a 
woman's  subsequent  children  are  all  boys.  In  the  following 
cases  the  left  ovary  was  removed,  and  the  subsequent 
pregnancies  gave  rise  to  boys  because  the  ova  necessarily 
were  derived  from  the  right  ovary,  hence  they  prove  my 
theory. 

Dr.  J.  A.  Wetherell's  case.^ — Left  ovary  removed,  sub- 
sequent birth  of  male  child.     Conception  after  ovariotomy. 

"The  patient,  Ann  H.,  unmarried;  at  the  age  of  twenty-five,  in 
1882,  her  menstruation  became  irregular,  and  she  first  noticed  a 
tumour  rising  in  her  abdomen.  Her  medical  attendant  diagnosed 
the  case  as  one  of  ovarian  tumour.  She  placed  herself  under  the 
care  of  Dr.  Granville  Bantock  in  the  Samaritan  Free  Hospital. 
The  case  was  one  of  fibroid  tumour  of  the  uterus  in  a  state  of  cysti- 
form  degeneration.     I  tried  to  lift  out  the  tumour,  but  it  so  invaded 

1  "  Lancet,"  April  28,  1888. 
76 


CHILDBEARING  AFTER  OVARIOTOMY         77 

the  broad  ligament  on  the  right  side  that  its  removal  in  the  usual 
way  was  impossible.  Fancying  there  was  nothing  to  be  done  but  to 
remove  the  ovaries,  with  a  view  of  checking  the  growth  of  the 
tumour,  I  removed  the  left  ovary,  which  was  easily  got  at. 

"  The  right  ovary  was  nowhere  to  be  found. 

"  I  now  looked  again  very  carefully  at  the  tumour,  and  as  it  felt 
as  if  there  might  be  some  deep-seated  fluid  in  it,  I  tapped  it,  and  got 
out  nearly  a  pint  of  dirty-looking  fluid.  There  was  no  way  of  re- 
moving the  tumour.  I  laid  the  tumour  very  freely  open.  She 
left  the  hospital  a  mere  shadow  of  herself  before  her  illness. 

"  For  four  years  she  enjoyed  fairly  good  health.  She  was  now 
quite  stout,  and  married. 

"  In  July  1887  I  delivered  her  of  a  fine  healthy  child.  She  nurses 
her  baby  boy  herself." 

Dr.  R.  H.  V.'s  case. — The  patient  was  married  in  April 
1900. 

"  The  first  child,  a  boy,  was  born  on  August  25,  1901.  In  March 
1902  her  left  ovary  was  removed  for  cystic  degeneration.  She  has 
had  four  pregnancies  since,  all  of  which  were  boys." 

The  doctor  writes  of  the  case  that,  "  if  mental  influence 
could  do  anything,  she  ought  to  have  had  girls,  as  she 
most  devoutly  wished  for  a  girl  each  time.'* 

Her  left  ovary,  however,  was  diseased,  and  so  removed; 
hence  the  subsequent  children  were  from  ova  from  the  right 
ovary,  and  therefore  were  boys. 

Dr,  Amand  Routh^  reports  a  case  of  tubal  pregnancy. 

"  Pregnancy  in  left  tube;  corpus  luteum  in  left  ovary.  The  right 
tube  was  normal;  a  nodule  could  be  felt  on  the  left  tube.  The  left 
ovary  and  tube  were  removed." 

The  report  on  the  specimen  by  Mr.  J.  H.  Targett  says : 

"  The  specimen  consists  of  the  (left)  Fallopian  tube,  ovary,  and 
adjacent  portion  of  the  broad  ligament.  The  ovary  contains  a  recent 
corpus  luteum.  The  histological  evidence  of  gestation  is  thus 
assured." 

It  follows  that  this  woman,  who  thus  had  her  left  tube  and 
left  ovary  removed  in  May  1898,  had  only  the  right  ovary 
remaining  to  produce  ova.  That  this  right  ovary  was 
functionally  active  is  evident  from  the  sequel,  for  Dr.  Routh 
writes  me  that  she  afterwards  "  became  pregnant  and  gave 
birth  to  a  boy  in  April  1899." 

1  "  Trans.  Obstet.  Soc,"  1898,  p.  222. 


yS  THE  CAUSATION  OF  SEX 

Dr.  Macnaughton-Jones^  describes  a  case  of  pregnancy 
after  removal  of  the  left  ovary  and  tube. 

"  In  February  1903,  at  the  operation,  the  sac  of  the  left  ovary 
was  found  about  the  size  of  an  orange  and  full  of  blood;  the  cyst 
of  the  left  ovary  with  the  left  tube  was  removed  entire.  Towards 
the  end  of  1895  menstruation  ceased,  and  I  found  she  was  pregnant. 
She  was  delivered  of  a  male  child  on  May  31st,  1896." 

Thus  this  woman  with  only  the  right  ovary  in  her  abdomen 
gave  birth  to  a  boy. 

Dr.  L.  B.  had  the  left  ovary  removed  from  a  patient, 
and  three  years  later  she  was  delivered  by  him  of  a  boy. 

Mrs.  B.  G.  had  had  disease  of  her  left  Fallopian  tube,  etc., 
for  years,  during  which  time  she  had  given  birth  to  two 
boys.  The  disease  continued,  till  finally  a  pyosalpinx  or 
abscess  in  the  tube  formed.  The  diseased  left  tube  and 
ovary  were  therefore  removed.  Two  years  afterwards  she 
gave  birth  to  another  boy,  the  ovum  having  necessarily 
come  from  the  right  ovary. 

Dr.  P.'s  case. — Mrs.  M.  F.  married  in  April  1902;  she 
became  pregnant  during  September  1902  in  her  left  Fallopian 
tube. 

She  was  admitted  to  hospital,  and  her  pregnant  left  tube 
and  left  ovary  were  removed. 

Less  than  two  years  afterwards,  in  August  1904,  she  was 
delivered  of  a  living  male  child. 

The  right  ovary,  the  only  one  remaining  in  her  abdomen, 
had  given  rise  to  a  boy. 

Similarly  if  the  right  ovary  be  entirely  removed,  any  ovum 
subsequently  fertilised  must  come  from  the  left  ovary,  and 
a  girl  will  be  born,  and  thus  will  support  my  theory. 

Dr.  McKerron^  has  a  paper  on  "  Obstruction  of  Labour 
by  Ovarian  Tumours  in  the  Pelvis."  Right  ovariotomy, 
subsequent  pregnancy,  and  birth  of  female  child.  The 
tumour  was  removed.  It  was  a  right  ovarian  dermoid. 
She  subsequently  became  pregnant  once  more,  having,  of 
course,  then  only  the  left  ovary  in  her  body.  She  was  de- 
livered on  January  15,  1897,  of  a  living  female  child. 

^  "  Diseases  of  Women,"  1900,  p.  667. 

2  "  Trans.  Obstet.  Soc.,"  1897,  PP-  337  ^-nd  339. 


CHILDBEARING  AFTER  OVARIOTOMY  79 

After  the  right  ovariotomy  the  left  ovary  must  of  necessity 
have  suppHed  the  ovum  which  was  fertiHsed,  hence  a  girl 
was  bom. 

Mr.  Alhan  Doran^  describes  a  case  of  right  tubal  preg- 
nancy. The  right  tube  and  right  ovary  were  removed. 
'*  The  left  tube  and  left  ovary  were  perfectly  normal,"  and 
therefore  were  not  removed.  Mr.  Doran  has  since  in- 
formed me  that  he  "  removed  the  whole  of  the  right  ovary 
on  December  2,  1899. 

"  The  uterus  was  not  pregnant  at  the  time  of  the  operation;  the 
patient  was  confined  of  a  girl  in  December  1900." 

Thus  having  only  the  left  ovary,  the  ovum  fertilised 
therefrom  produced  a  female  child. 

Mrs.  D.  C.  had  her  right  ovary  and  tube  removed  by 
Dr.  J.  Oliver.  She  has  since  been  pregnant  on  two  occasions, 
a  female  child  being  born  each  time. 

I  delivered  her  of  her  second  girl  in  April  1903,  having 
assured  her  it  would  be  a  girl  directly  she  became  pregnant. 

Mrs.  B.  P.  had  three  boys  born.  When  the  youngest  was 
nearly  ten  years  old  an  abdominal  tumour  developed.  At 
the  operation  her  right  ovary  was  removed  for  a  tumour  in 
it.  Subsequently  a  girl  was  born,  just  three  years  after  the 
operation. 

Her  right  ovary  having  been  removed,  she  had  only 
one  ovary  remaining  in  the  abdomen,  namely  the  left,  and 
a  female  child  was  derived  therefrom. 

H.  B.  Mylvaganam,^  in  a  case  of  advanced  pregnancy 
and  ovarian  cyst,  performed  abdominal  section,  and  tapped 
and  removed  a  large  cyst  of  the  right  ovary.  He  then 
performed  Caesarean  section,  and  "  a  viable  female  foetus 
about  eight  months  old  was  removed." 

In  this  case  it  was  evident  that  the  girl  had  come  from  the 
healthy  left  ovary,  the  right  ovary  being  diseased  and 
occupied  by  a  "  large  thin- walled  cyst  containing  smaller 
cysts,"  which  had  existed  "for  the  past  few  years,"  and 
for  which  she  had  been  tapped  four  times  and  fluid  had  been 
drawn  out."     The  left  ovarian  origin  of  the  ovum  is  evident. 

1  "Trans.  Obstet,  Soc,"  1900,  p.  135. 

2  H.  B.  Mylvaganam,  F.K.C.S.,  in  "  Lancet,"  July  29,  191 1,  p.  297. 


8o  THE  CAUSATION  OF  SEX 

The  Effects  of  Bilateral  Ovariotomy. — It  seems  difficult  to 
realise  that  any  other  result  than  absolute  sterihty  can 
possibly  follow  the  removal  by  operation  of  both  ovaries. 

There  are,  however,  on  record  a  dozen  cases  of 

PREGNANCY   FOLLOWING  THE  SO-CALLED   REMOVAL   OF   BOTH 
OVARIES. 

It  will  of  course  be  at  once  evident  that  the  supposed 
removal  was  not  complete,  a  portion  of  one  or  other  ovary 
being  allowed  to  remain  in  the  abdomen.  There  is,  as  far 
as  I  can  gather,  no  case  on  record  of  a  portion  of  both  ovaries 
being  inadvertently  allowed  to  remain  and  different-sexed 
twin-pregnancy  following. 

In  one  extreme  case  quoted  by  Parvin^ — 

"  Olshausen  performed,  as  he  thought,  ovariotomy;  but  the  result 
being  fatal,  he  found  at  the  autopsy  that  neither  ovary  had  been 
removed." 

Complete  removal,  then,  of  all  ovarian  tissue  from  both 
sides  absolutely  stops  ovulation,  and  therefore  leads  to  per- 
manent sterility;  menstruation,  too,  is  permanently  arrested. 

I  do  not  propose  here  to  go  further  into  the  question  of 
the  results  of  incomplete  operations,  which  I  have  con- 
sidered in  Chapter  XXI.,  beyond  pointing  out  the  fact 
that,  as  a  small  portion  of  an  ovary  can  carry  on  its  functions, 
the  operation  known  as  resection  of  an  ovary  has  been 
introduced. 

The  Effects  of  Resection  of  an  Ovary. — Resection  of  an 
ovary  is  an  operation  by  which,  in  a  partially  diseased 
ovary,  the  diseased  part  only  is  removed,  the  healthy  part 
being  allowed  to  remain.  This  conservative  operation  is 
due  to  the  appreciation  of  the  fact  that  a  very  small  piece 
even  of  an  ovary  is  sufficient  to  ensure  the  production  of 
fertilisable  ova,  so  that  pregnancy  may  follow  the  entire 
removal  of  one  ovary  and  the  partial  removal  or  resection 
of  its  fellow.  Hence  it  follows  that  resection  of  one  ovary 
and  entire  removal  of  the  other  resembles  incomplete 
bilateral  ovariotomy  in  its  results. 

The  actual  effect  as  regards  the  sex  of  children  born  after 
resection  of  one  ovary  depends  necessarily  on  whether  the 
opposite  ovary  has  been  entirely  removed  or  not. 

^  Parvin,  "  Science  and  Art  of  Obstetrics,"  1895,  3rd  ed.  p.  107. 


CHILDBEARING  AFTER  OVARIOTOMY         8i 

If  not  removed,  the  woman  can  have  either  sexed  children, 
or  "  pigeon-paired  "  twins,  because  there  is  one  complete 
ovary  and  part  of  the  opposite  one. 

If  the  opposite  ovary  have  been  entirely  removed,  she 
can  have  but  one  sex  of  children,  which  will  correspond  to 
the  ovary  resected. 

The  following  is  a  case  in  point,  which  very  characteristic- 
ally supports  my  theory : 

Mrs.  Stanley  Boyd^  operated  on  a  patient  and  entirely 
removed  the  right  ovary.  She  resected  the  left  ovary,  as  a 
portion  of  it  showed  early  cystic  disease.  The  cystic  portion 
was  removed,  and  the  healthy  part  of  the  left  ovary  was 
allowed  to  remain  in  the  abdomen. 

The  patient  subsequently  became  pregnant,  and  was 
duly  delivered  of  a  girl. 

Necessarily  the  healthy  remainder  of  the  left  ovary  must 
have  provided  the  ovum,  and  consequently  the  child  born 
was  a  female. 

Besides  strikingly  supporting  my  theory,  this  case  also 
exemplifies  very  plainly  a  fact  which  many  critics  either 
cannot  or  will  not  realise — viz.  that  the  complete  removal 
of  an  ovarian  tumour  is  not  synonymous  with  the  complete 
removal  of  all  the  ovarian  tissue  on  the  same  side  as  the 
tumour. 

One  cannot  but  regret  that  writers  so  often  fail  to  record 
of  which  ovary  it  is  that  a  portion  is  healthy,  and  so  allowed 
to  remain  in  the  abdomen;  and  also  fail  to  record  the  sex 
of  the  child  subsequently  born. 

From  an  interesting  paper  by  Mrs.  S.  Boyd^  it  appears 
that  probably  20  per  cent,  of  women  become  pregnant  after 
such  operations. 

^  "  British  Medical  Journal,"  "  Conservative  Surgery  of  Tubes  and 
Ovaries,"  Sept.  15,  1900. 

2  Mrs.  S.  Boyd,  "  Journal  of  Obstetrics  and  Gynaecology,"  vol.  ill., 
March  1903,  p.  241. 


CHAPTER  XI 

CASES  OF  PREGNANCY  IN  ABNORMAL   UTERI 
WHICH  PROVE  THE  THEORY 

It  has  been  pointed  out  in  the  chapter  on  Anatomy  that 
the  uterus  in  the  human  female  is  a  single-cavity-containing 
organ  formed  by  the  fusion  of  the  two  ducts  of  Miiller. 

If  these  two  tube-like  ducts,  from  which  the  uterus  is 
developed,  do  not  properly  coalesce,  the  uterus  in  the  human 
female  becomes  double,  and  is  known  as  a  bi-cornuate  uterus. 

The  diverging  branches  of  the  uterus  are  known  as  cornua 
or  horns,  a  right  and  a  left,  and  their  cavities  being  more 
or  less  separated,  the  whole  cavity  comes  to  be  somewhat 
Y-shaped,  and  thus  it  resembles  the  uterus  of  many  of  the 
mammalia.     Cf.  Fig.  4,  p.  10. 

Though  the  uterus  be  thus  doubled,  the  number  of 
ovaries  and  Fallopian  tubes  remain  the  normal,  only  one 
ovary  and  one  tube  being  associated  with  each  half  of  the 
uterus. 

Pregnancy  occurs  in  these  as  in  normal  uteri,  and  the  child 
derived  from  the  right  ovary  usually  develops  in  the  right 
cornu,  and  that  from  the  left  ovary  in  the  left  cornu;  thus 
these  cases  confirm  and  prove  the  theory. 

Dr.  A.  E.  Giles ^  in  describing  a  case  of  complete  double 
uterus,  states  that  the  right  half  of  the  woman's  uterus  had 
never  been  pregnant,  the  mouth  of  this  right  half  of  the 
womb  being  small,  round,  and  virginal.  The  left  half  or 
cornu  of  the  uterus  had  been  pregnant.  It  was  the  larger 
of  the  two,  and  its  mouth  was  opened  and  elongated  trans- 
versely, showing  a  child  had  passed  through  it.  She  had 
given  birth  to  one  child  only,  a  girl,  which  was  alive.  That 
is,  the  left  side  of  a  double  uterus  had  brought  forth  a 
female  child. 

1  Giles,  "  Trans.  Obstet.  Soc,"  vol.  xxxvii.  1895,  p.  305. 
82 


CASES  OF  PREGNANCY  IN  ABNORMAL  UTERI     83 

Jurinka^  describes  a  case,  of  which  an  abstract  is  given 
in  the  above  journal,  of  double  uterus.  The  left  half  was 
not  pregnant. 

"  The  cavity  of  the  gravid  right  half  contained  an  embryo  of  the 
male  sex." 

There  is  no  mention  of  a  corpus  luteum,  unfortunately, 
but  the  right  side  of  a  double  uterus  had  brought  forth  a 
male  child. 

Thus  these  two  cases  strikingly  confirm  the  theory. 

Lusk^  mentions  that  Professor  Fordyce  Barker  had  a 
case  of  "  double  uterus."  "  A  mature  living  male  child 
was  born  on  July  10,  and  on  September  22  following  the 
mother  gave  birth  to  a  full-term  living  girl."  So  that  each 
half  of  a  double  uterus  produced  a  full-time  child  of  different 
sex,  but  which  side  contained  which  is,  most  unfortunately, 
not  given. 

Dr.  M.  Handfield- Jones, ^  in  a  case  of  double  uterus, 
found  the  left  side  pregnant,  and  the  corpus  luteum  in  the 
left  ovary,  but  no  sex  of  the  child  was  given. 

Dr.  Walls  ^  described  an  unusual  case  where,  from  a  double 
uterus,  a  male  child  was  delivered.  The  placenta  was 
attached  in  the  right  half  of  the  uterus,  and  the  greater 
part  of  the  child  was  in  the  left  half,  its  '*  head  being  in 
a  cavity  between  the  two  cornua." 

Possibly  before  labour  set  in  it  was  entirely  in  the  left 
horn;  but  the  fact  is  evident  that  the  male  child  first  de- 
veloped in  the  right  half,  as  shown  by  the  location  of  the 
placenta. 

Hence  this  case  is  confirmatory  also. 

Ollivier^  reported  a  case  where  a  woman  had  been  preg- 
nant on  six  occasions,  all  in  the  left  half  of  a  double  uterus. 
The  "  right  half  of  the  uterus  was  virginal,  the  left  half 
larger  and  more  developed." 

Unfortunately,  the  sex  of  the  children  is  not  given. 

1  Jurinka,  "  Journal  of  Obstetrics  and  Gynaecology,"  vol.  v.,  Feb.  1904, 
p.  173;  and  "  Brit.  Medical  Journal,"  Epitome,  Dec.  1903. 

2  "  Science  and  Art  of  Midwifery,"  1892,  p.  231. 

3  "  Trans.  Obstet.  Soc,"  vol.  xxix.  1887,  p.  146. 
*  Dr.  Walls,  "  Practitioner,"  Jan.  1903,  p.  82. 

^  "  Gazette  Medicale  de  Paris,"  1872,  p.  163. 


84  THE  CAUSATION  OF  SEX 

In  some  cases  of  double  uterus,  the  two  halves  of  the 
uterus  are  not  equally  developed. 

In  a  case  where  the  right  half  of  the  uterus  had  thus 
only  partially  developed,  Mr.  J.  H.  Targett^  removed  it 
and  its  contained  child,  which  was  a  boy.  That  is,  the 
right  half  of  the  uterus  had  brought  forth  a  male  child. 
The  left  half  of  the  uterus  was  empty. 

It  is  in  these  cases  of  double  uterus  that  migration  of 
the  ovum  most  frequently  takes  place,  for  we  find  a  foetus 
in  one  cornu  and  the  corpus  luteum  in  the  ovary  of  the 
other  side.  External  migration  of  the  ovum  must  neces- 
sarily occur  in  those  cases  where  the  two  cornual  cavities 
do  not  coalesce  above  a  common  cervix,  but  each  ends  in  a 
separate  cervix.  There  is  no  evidence  to  warrant  a  belief 
that  a  fertiUsed  ovum  can  pass  out  of  the  cornu  and 
cervix  of  one  side  into  the  single  vagina,  and  thence  pass 
through  the  other  cervix  into  the  cornu  of  the  opposite 
side ;  certainly  it  cannot  do  so  if  the  vagina  is  also  doubled 
and  distinct. 

Dr.  Lewers^  showed  a  specimen  consisting  of  pregnancy  in 

"  the  rudimentary  left  uterine  cornu,  with  the  left  Fallopian  tube 
and  ovary  attached  to  it.  The  ovary  does  not  contain  the  corpus 
luteum,  so  that  the  case  must  have  been  an  example  of  the  external 
migration  of  the  ovum  from  the  opposite  ovary  "  (the  right). 

The  child  was  a  boy. 

Here  is  a  case  of  a  male  child  developing  in  the  left 
rudimentary  half  of  a  uterus,  and  the  left  ovary  proved  not 
to  have  provided  the  ovum:  a  most  convincing  case.  The 
right  ovary  was,  of  course,  not  examined,  but  remains  in 
the  abdomen. 

A  somewhat  similar  case  is  recorded  by  Sir  T.  Rudolph 
Smith^  and  Dr.  H.  Williamson.  The  specimen  was  "  a 
dilated  rudimentary  left  uterine  cornu  bearing  a  foetus." 
The  left  ovary  was  small  and  normal.  No  mention  of  corpus 
luteum  in  it,  as  it  was  evidently  not  in  it,  because,  owing  to 
the  fact  that  "  the  pedicle  attaching  the  sac  to  the  uterus 
was  imperforate,"  the  means  by  which  the  oosperm  reached 

^  Targett,  "  Trans.  Obstet.  Soc,"  vol.  xlii.  1900,  p.  276. 

2  "  Trans.  Obstet.  Soc,"  vol.  xlvii.  1905,  p.  113. 

^  "  Journal  of  Obstetrics  and  Gynaecology,"  vol.  iii.  1903,  pp.  27-30. 


CASES  OF  PREGNANCY  IN  ABNORMAL  UTERI      85 

this  rudimentary  cornual  cavity  must  have  been  by  external 
migration  of  the  ovum. 

The  normal  right  tube  and  ovary  remain  in  the  abdomen, 
and  the  latter  undoubtedly  contains  the  corpus  luteum. 

Note  that  the  left  ovary  is  described  as  small,  therefore 
not  enlarged  by  the  growth  of  a  corpus  luteum  in  it.  In  a 
private  letter  Sir  Rudolph  Smith  tells  me  the  child  was 
a  boy. 

The  ovum,  I  maintain,  must  have  come  from  the  right 
ovary,  and  the  child  was  a  male;  it  is  a  similar  case  to  on.e 
published  by  Howard  Kelly. 


CHAPTER  XII 

THE  CORPUS  LUTEUM  AS  A  SIGN  OF 
PREGNANCY 

Pregnancy  manifestly  cannot  occur  without  the  provision 
of  an  ovum,  so  that  ovulation  precedes  pregnancy. 

The  ovum  is  extruded  by  the  bursting  of  a  Graafian 
follicle.  The  ruptured  follicle  filled  with  blood  is  the  first 
stage  in  the  formation  of  a  corpus  luteum,  hence  ovulation 
is  always  followed  by  the  formation  of  a  corpus  luteum. 

The  difference  between  the  corpus  luteum  of  menstrua- 
tion and  that  of  impregnation,  or  the  "  false  "  and  the 
**  true  "  corpus  luteum,  has  already  been  pointed  out  to  be 
one  of  size  only ;  the  larger  s'ze  of  the  true  corpus  luteum  being 
due  to  the  increased  congestion  or  blood  supply  incident  to 
pregnancy. 

Hence  it  follows  that  pregnancy  is  practically  invariably 
shown  by  the  presence  of  a  true  corpus  luteum,  and  I  have 
throughout  looked  upon  the  presence  of  a  true  corpus 
luteum  as  not  only  indicative  of  pregnancy,  but  as  indicative 
of  the  ovary  which  provided  the  fertilised  ovum. 

As  Hirst  ^  says : 

"  The  true  corpus  luteum  is  of  value  as  an  indication  of  the  ovary 
from  which  the  impregnated  ovule  came." 

But  a  large  corpus  luteum  has  been  found  in  some  in- 
stances where  no  pregnancy  has  existed. 

In  the  great  majority  of  such  cases,  where  the  uterus  has 
not  contained  a  foetus,  it  has  contained  a  growing  myoma 
or  fibroid  tumour. 

Two  such  cases  are  mentioned  by  Sir  J.  Bland-Sutton^-^  a 
myoma  being  present  in  each;  while  in  a  third  instance 

1  Hirst,  "  Obstetrics,"  p.  63. 

2  Bland-Sutton,  "  Surgical  Diseases  of  Ovaries,"  1896,  p.  18 

86 


CORPUS  LUTEUM  AS  A  SIGN  OF  PREGNANCY  87 

related  by  Sir  J.  Bland-Sutton,'^  not  only  was  the  ovary  which 
contained  the  well-marked  corpus  luteum  itself  occupied  by 
a  large  dermoid  tumour,  but  the  "  uterus  contained  a  large 
myoma  which  blocked  up  the  pelvic  cavity." 

He  therein  also  states  he  has  seen  several  other  instances 
in  association  with  myomata;  and  other  cases  have  been 
described  by  Dr.  Herman^  and  Dr.  Popow,^  a  fibroid  being 
present  in  every  case. 

A  placental  polypus  has  also  been  known  to  act  like  a 
fibroid,  and  cause  a  subsequent  menstrual  corpus  luteum 
to  develop  like  one  due  to  pregnancy. 

Undoubtedly  the  presence  in  the  uterus  of  a  fibroid 
tumour  and  the  irritation  of  its  growth  acting  reflexly  on 
the  ovary  similarly  to  what  a  foetus  does,  cause  the  corpus 
luteum  of  menstruation  to  grow  into  a  large  or  true  corpus 
luteum  indistinguishable  from  one  due  to  pregnancy,  or,  as 
Dr.  Galahin  "^  expresses  it — 

"  A  fibroid  causes  a  corpus  luteum  like  that  of  pregnancy,  owing 
to  undue  congestion." 

One  other  cause  of  a  "  true  "  corpus  luteum  in  women 
whose  uterus  contains  no  foetus  has  been  discovered  in 
prostitutes,  and  Dr.  Popow^  has  described  such  a  case. 

Here  the  life  of  drink  and  venery  provides  that  irritation, 
stimulation,  and  "  undue  congestion,"  which  would  lead 
to  the  growth  from  the  "  false  "  to  the  "  true  "  corpus 
luteum. 

Some  other  cases  are  doubtless  due  to  the  occurrence  of 
extra-uterine  gestation,  a  tubal  mole  or  abortion  being  over- 
looked, for  the  lately  pregnant  tube  very  quickly  returns  to 
its  normal  condition  and  appearance,  and  the  fact  that  it 
had  been  pregnant  is  missed.  Dr.  Cullingworth^  has 
exhibited  and  described  a  Fallopian  tube  which  had  within 
ten  hours  of  its  rupture,  and  extrusion  of  an  early  ovum, 
entirely  resumed  its  normal  size  and  appearance.     Had  it 

1  Bland-Sutton,  "  Trans.  Obstet.  Soc,"  vol.  xxxiv.  1892,  p.  6, 

2  Herman,  Ibid.,  vol.  xxxiv.  1892,  p.  10. 

3  Popow,  Ibid.,  vol.  xxiv.  1882,  p.  100. 

*  Galabin,  "  Manual  of  Midwifery,"  1900,  p.  45. 

5  Popow,  loc.  cit. 

^  "  Trans.  Obstet.  Soc,"  vol.  xlii.  1900,  p.  129. 


88 


THE  CAUSATION  OF  SEX 


not  been  for  the  rent  and  the  microscopic  detection  of 
chorionic  vilU,  it  would  have  been  impossible  to  recognize 
it  as  having  recently  contained  an  ovum.  See  Sir  J.  Bland- 
Sutton's^  diagram  of  a  normal-looking  tube  after  recent 
complete   tubal   abortion:   there  is   a  well-marked  corpus 


Fig.  14, — A  Recently  Pregnant  Fallopian  Tube,  which  has 
ABORTED  the  Large  Mole  SHOWN.     (After  Bland-Sutton.) 

There  is  a  well-marked  corpus  luteum  displayed  in  the  opened  ovary. 


luteum  in  the  ovary;  the  uterus  would  of  course  contain 
no  foetus  in  this  case. 

A  few  cases  of  pregnancy  and  no  corpus  luteum  have  been 
stated  to  have  been  seen.  The  rate,  however,  at  which  a 
corpus  luteum  disappears  occasionally  varies;  thus  W. 
Williams^  says: 

"  In  young  women,  in  whom  the  circulation  is  active,  the  de- 
generated lutein  cells  are  rapidly  absorbed,  so  that  in  a  short  time 
the  corpus  luteum  becomes  replaced  by  a  newly  formed  connective 

1  Bland-Sutton,  "  Diseases  of  Women,"  1904,  p.  290. 

2  Williams,  op.  cit.,  p.  68. 


CORPUS  LUTEUM  AS  A  SIGN  OF  PREGNANCY  89 

tissue,  which  corresponds  closely  in  appearance  to  the  surrounding 
ovarian  stroma.  But  in  more  advanced  life,  when  the  ovarian 
circulation  has  become  impaired,  absorption  goes  on  less  rapidly." 

It  is  probable,  therefore,  that  in  these  cases  the  corpus 
luteum  has  become  absorbed  more  rapidly  than  usual,  and 
so  has  not  been  recognised. 

We  come  then  to  the  conclusion  that  a  true  corpus  luteum 
is  always  present  during  pregnancy,  and  is  indicative  of  it, 
or  as  Parry  ^  puts  it — 

"  The  presence  (of  the  corpus  luteum  in  pregnancy)  is  the  rule, 
;  absence  is  the  exception,  especially  in  the  early  months  of  ges- 

finn  " 


its 
tation 


1  Parry,  "  Ectopic  Pregnancy." 


CHAPTER  XIII 

THE  MIGRATION  OR  TRANSMIGRATION  OF 
THE  OVUM 

Among  the  cases  which  might  at  first  sight  have  appeared 
to  disprove  my  theory,  are  those  where  the  corpus  luteum 
is  found  in  one  ovary,  while  the  foetus  is  found  in  the 
opposite  Fallopian  tube ;  or  the  opposite  cornu,  if  the  human 
uterus  happen  to  be  of  the  mammalian  or  bifid  form.  In 
these  cases,  the  sex  of  the  foetus  corresponds  to  the  ovary  in 
which  the  corpus  luteum  is  found. 

Bischoff,  in  1844,  was  the  first  to  call  attention  to  the  fact 
that  occasionally,  in  animals  with  a  bicornuate  or  bifid 
uterus,  the  corpus  luteum  may  be  in  one  ovary  and  the 
embryo  in  the  opposite  cornu  or  branch  of  the  uterus. 

This  he  ascribed  to  a  migration  of  the  ovum,  and  alleged 
that  the  fertilised  ovum  had  come  from  the  ovary  in  which 
the  corpus  luteum  was  found,  and  had  made  its  way  into 
the  cornu  of  the  opposite  side  instead  of  attaching  itself 
to  the  wall  of  the  cornu  corresponding  to  the  ovary  from 
which  it  was  derived.  This  explanation  is  certainly  the 
correct  one. 

Kussmaul  first  described  its  occurrence  in  woman,  especi- 
ally in  tubal  pregnancies,  and  pointed  out  that  it  might 
arise  either  (a)  owing  to  the  ovum  passing  from  one  ovary 
across  the  pelvic  cavity  along  the  peritoneal  surfaces  of  the 
intestines,  into  the  external  opening  of  the  opposite  tube, 
which  he  called  the  External  Migration  of  the  ovum,  or 
(h)  from  its  passing  down  one  tube,  then  across  the  uterine 
cavity  and  so  up  into  the  opposite  tube,  which  variety  he 
called  Internal  Migration  of  the  ovum. 

Hirst ^  says: 

"It  is  possible  for  the  ovum,  after  its  discharge  from  the  ovary, 
to  be  taken  up  by  the  fimbriated  extremity  of  the  opposite  tube — 
an  external  transmigration  of  the  ovum. 

^  Hirst,  "  Obstetrics,"  1900,  p.  62. 
90 


MIGRATION  OR  TRANSMIGRATION  OF  OVUM     91 

"It  is  also  possible  for  the  ovum  to  traverse  one  tube  and  the 
uterine  cavity,  and  to  enter  the  uterine  ostium  of  the  opposite  tube, 
— an  internal  transmigration  of  the  ovum." 

Both  forms  of  migration  of  the  ovum  are  credited  by, 
among  others,  Dr.  Herman,^  who  said: 

"  There  was  abundant  evidence  in  support  of  the  external  migra- 
tion of  the  ovum,  and  some  evidence  in  favour  of  internal  migration." 

W.  Williams^  says  external  migration  "  is  probably  by  no 
means  rare,"  and  further  points  out  that  proof  of  internal 
migration  is  very  difficult  to  bring  forward,  though  "  its 
theoretical  possibility  cannot  be  denied." 

It  will  be  necessary  to  discuss  each  event,  to  show  that 
the  occurrence  is  rather  proof  of  the  theory  than  otherwise. 

The  external  migration  of  the  ovum,  or  transperitoneal 
migration,  as  Dr.  Galahin  describes  it,  means  that  an  ovum 
reaches  the  opposite  tube  without  passing  through  the  uterus. 
It  was  described  by  Barnes^  as  Extra-Uterine  Transmigra- 
tion of  the  ovum. 

In  the  normal  condition  of  the  tubes  and  ovaries,  the  great 
majority  of  the  ova,  after  leaving  the  ovary,  enter  the  nearer 
or  corresponding  tube ;  but,  as  Sir  J.  Bland-Sutton  *  says : 

"  Probably  a  certain  number  of  ova  fail  to  enter  the  Fallopian  tube, 
and  are  lost  in  the  peritoneal  cavity." 

But  not  all  are  lost  because  they  miss  the  nearer  tube, 
for,  falling  into  the  general  peritoneal  cavity,  they  are  caught 
up  in  the  thin  capillary  layer  of  serous  fluid  which  bathes 
the  surfaces  of  the  organs  and  intestines.  This  fluid  acts 
by  keeping  their  surfaces  moist,  and  by  thus  preventing 
them  from  drying  or  adhering  to  each  other,  it  enables  one 
coil  of  intestine  to  readily  pass  over  another. 

The  peristaltic  movements  of  the  intestines,  as  well  as 
the  natural  changes  in  posture  of  the  woman,  must  help 
to  carry  small  floating  bodies  like  ova  along  the  moist  sur- 
faces of  the  pelvic  viscera.  In  this  thin  layer  of  fluid  a 
current  exists,  due  to  the  wavy  motion  of  the  cilia  or  hair- 

1  Herman,  "  Trans.  Obstet.  Soc,"  vol.  xlvi.  p.  103. 

2  Whitridge  Williams,  "  Obstetrics,"  pp.  79,  80. 

3  Barnes,  "  Midwifery,"  1878,  p.  346. 

*  Bland-Sutton  and  Giles,  "  Diseases  of  Women,"  1900,  p.  18. 


92  THE  CAUSATION  OF  SEX 

like  processes  lining  the  fimbriated  ends  of  the  Fallopian 
tubes,  and  this  current  runs  towards  the  large  open  abdominal 
end  of  the  tubes,  and  so  down  the  tubes  into  the  uterine 
cavity. 

But  in  addition  to  the  peritoneal  fluid  or  serum,  we  also 
have  the  follicle  fluid  (Liquor  FoUiculi),  together  with  a 
little  blood,  which  is  discharged  when  the  ovum  escapes  by 
the  bursting  of  the  ovarian  or  Graafian  follicle.  This  must 
help  also  to  float  the  ovum  onwards  towards  one  or  other 
tubal  end. 

As  W.  Williams^  says: 

"The  correctness  of  this  view  has  been  substantiated  by  the 
experimental  work  of  Pinner,  Jani  and  Lode.  The  former  injected 
cinnabar,  and  the  latter  ova  of  ascarides,  into  the  peritoneal  cavity 
of  animals,  and  found  that  they  made  their  way  to  the  pelvis,  where 
they  were  taken  up  by  the  tubes,  through  which  they  were  carried 
to  the  uterus,  and  eventually  appeared  in  the  vagina." 

As  was  recently  pointed  out  by  Dr.  R.  Boxall,^  the  peri- 
toneal cavity  is,  during  life,  with  the  abdomen  unopened, 
a  cavity  in  name  only,  the  pelvic  organs  and  intestines 
being  in  close  apposition.     It  was  therefore — 

* '  quite  easy  to  imagine  how  the  ovum,  floating  about  like  a  drop 
of  oil,  might  readily  find  its  way  from  one  ovary  to  the  abdominal 
ostium  of  the  Fallopian  tube  of  the  opposite  side,  and  so  be  swallowed ' ' ; 

while  Dr,  Cullingworth,^  after  pointing  out  that  not  only 
were  the  ovaries  and  abdominal  ostia  of  the  tubes  closer 
together  than  was  generally  supposed,  but  were  often  in 
actual  contact,  said: 

"  Writers  spoke  of  the  ovum  travelling  across  the  peritoneal 
cavity,  and  conveyed  the  impression  of  a  long  and  almost  incon- 
ceivable journey,  whereas  the  ovum  might  merely  have  to  step 
in  next  door." 

Harrison  Cripps  and  H.  Williamson^  reported  a  case  of 
tubal  gestation  with  external  migration  of  the  ovum. 

Howard  Kelly  has  reported  a  case  of  removal  of  the  right 

1  Whitridge  Williams,  "  Obstetrics,"  1903,  p.  79 

2  "  Trans.  Obstet.  Soc.,"  1904,  vol.  xlvi.  p.  104. 
^  Loc.  cit.,  p.  105. 

*  "  Brit.  Med.  Journ.,"  March,  1904. 


MIGRATION  OR  TRANSMIGRATION  OF  OVUM     93 

Fallopian   tube   and   the   left   ovary.     The   patient   subse- 
quently conceived  intra-uterine,  and  bore  a  healthy  child — 

"  The  ovum  necessarily  passing  from  the  right  ovary  up  the  left 
uterine  tube,  and  so  into  the  uterus." 

Kiistner  has  reported  a  similar  case. 

I  have  thus  shown  how  external  migration  may  occur 
with  the  tubes  and  ovaries  normally  situated  or  stationary; 
it  must  evidently  more  readily  occur  if  the  two  tubes  and 
ovaries  should  be  misplaced,  or  in  any  way  approximated 
to  the  same  side. 

The  tubes  are,  it  is  generally  admitted,  very  freely  mov- 
able, and  there  can  be  no  doubt  that  when  a  woman  is 
lying  on  one  side,  gravity  may  help  the  upper  tube  to  cross 
over  or  fall  down  towards  the  side  she  lies  on,  and  thus 
cross  over  the  body  of  the  uterus,  so  that  the  tube's  ex- 
panded abdominal  opening  is  nearer  to  the  opposite,  or 
lower-in- the-pel vis,  ovary;  and  thus  it  may  come  to  pass 
that  an  ovum  has  almost  a  choice  of  tubes  to  enter.  This 
used  to  be  described  as  the  tube  of  one  side  grasping  the 
opposite  ovary.  That  the  tube  ever  actually  grasped  the 
ovary  was  incorrect,  but  it  grasped  an  ovum,  for  by  ap- 
proximating its  open  end  to  the  ovary  of  the  opposite  side, 
it  is  only  reasonable  to  suppose  it  occasionally  secured, 
grasped,  or  received  an  ovum  from  that  opposite-sided  ovary. 

Dr.  Byron  Robinson^  writes  that,  owing  to  its  "  wide 
range  of  movement,  the  abdominal  or  ampullar  end  of  the 
tube  is  capable  of  securing  ova  from  either  ovary." 

A  case  is  described  by  Alhan  Doran^  where  the  dilated 
right  pregnant  tube  "  had  fallen  behind  the  uterus  and 
developed  towards  the  left  side." 

He  removed  the  right  tube  and  the  right  ovary,  which 
contained  no  corpus  luteum.  The  left  tube  and  ovary, 
being  normal,  were  not  touched ;  as  the  right  ovary  contained 
no  corpus  luteum,  the  sign  of  ovulation,  the  ovum  must  have 
come  from  the  opposite  left  ovary,  and  got  into  the  right 
tube,  which  had  become  approximated  to  the  left  ovary — 
that  is,  it  migrated,  or  entered  the  opposite  tube. 

^  Dr.  Byron  Robinson,  "  Anatomy  of  the  Oviduct,"  Feb.  1903. 
2  Doran,  "  Trans.  Obstet.  Soc,"  1900,  p.  135. 


94  THE  CAUSATION  OF  SEX 

This,  which  may  be  described  as  normal  or  temporary 
approximation  of  the  tubes  to  one  side,  occasionally  becomes 
permanent  and  pathological  through  adhesions  binding 
both  tubes  down  to  one  side. 

Sir  J.  Bland-Sutton^  has  described  and  figured  such  a  case ; 
both  tubes  are  lying  attached  to  the  left  side  of  the  uterus, 
so  that  the  right  tube  is  more  likely  to  receive  a  left  ovum 
than  one  from  its  own,  or  right  ovary. 

In  other  cases  the  tube  of  one  side  may  be  of  extra  or 
abnormal  length,  and  this,  in  conjunction  with  its  mobility, 
must  increase  the  probability  of  its  open  end  occasionally 
falling  in  close  proximity  to  the  ovary  of  the  opposite  side, 
and  thus  securing  an  ovum  from  it. 

Dr.  T.  Wilson^  describes  a  case  of  extra  long  tube,  where, 
instead  of  the  average  length  of  four  inches,  "  the  left 
Fallopian  tube  runs  longitudinally  to  the  left  for  nine 
inches." 

Occasionally,  too,  we  find,  as  in  cases  by  Dr.  Herman^ 
and  Sir  J .  Bland- Sutton,'^  a  tube  is  misplaced,  and  fixed  up 
to  the  top  of  the  uterus,  and  in  this  position,  therefore,  it  is 
as  likely  to  receive  an  ovum  from  the  opposite  ovary  as 
from  its  own  ovary. 

In  other  cases  both  tubes  and  ovaries  are  displaced  back- 
wards behind  the  uterus,  hence  it  becomes  equally  possible 
for  a  tube  to  receive  an  ovum  from  the  opposite  ovary  as 
from  its  own  ovary.     Thus  Howard  Kelly ^  says: 

"  I  have  repeatedly  found  both  tubes  and  ovaries  lying  low  down 
behind  the  uterus,  with  the  fimbriated  extremity  of  the  right  tube 
in  contact  with  the  left  ovary  and  vice  versa." 

Dr.  Giles^  describes  such  a  case.  The  pregnancy  was  in 
the  left  tube,  corpus  luteum  in  right  ovary,  none  in  left 
ovary. 

Both  tubes  and  both  ovaries  were  bent  backwards  behind 
the  uterus,  so  that  the  receipt  of  the  ovum  by  the  left  tube 
from  the  right  ovary  is  not  difficult  to  realise. 

1  Bland-Sutton,  "  Trans.  Obstet.  Soc,"  1892,  pp.  9  and  10. 

2  Wilson,  Ibid.,  1897,  p.  172. 

3  Herman,  Ibid.,  1897,  P-  I35- 

4  Bland-Sutton,  Ibid.,  1897,  p.  164. 

*  Kelly,  "  Operative  Gynaecology,"  2nd  ed.,  vol.  ii.,  p.  449,  1906. 
6  Giles,  "  Trans.  Obstet.  Soc,"  1897,  p.  244. 


'  MIGRATION  OR  TRANSMIGRATION  OF  OVUM     95 

I  have  thus  shown  that  we  may  have — 

Extra  long  tubes. 

Displaced  tubes,  so  that  both  approximate  one  ovary, 

either  both  tubes  backwards,  or  to  the  same  side  of 

uterus,  or  to  the  top  of  uterus. 

But  besides  these  misplacements  of  the  tubes,  we  may  also 
have  the  ovaries  displaced — so  much  so  that  one  tube  may 
almost  have  a  choice  of  ovaries  to  secure  an  ovum  from. 

Dr.  R.  Pollock^  says: 

"  In  both  ovaries  there  was  a  dermoid  tumour;  the  left  ovary  was 
lying  over  the  right  in  the  right  iliac  fossa,  and  was  fixed  there  by  a 
piece  of  omentum." 

Glockner^  reported  a  case  of  right  cornual  pregnancy,  no 
corpus  luteum  in  right  ovary,  but  in  the  left,  thus  supporting 
migration  of  ovum. 

There  is  also  some  evidence  of  the  occasional  trans- 
peritoneal migration  of  the  spermatozoa  as  well  as  of  the 
ova. 

We  can  therefore  take  it  as  settled  that  External  Migration 
of  the  ovum  does  take  place  in  mankind,  and  the  probability 
of  its  occurrence  is  increased  by  the  frequent  misplacements 
of  one  tube,  or  ovary  even,  as  well  as  by  the  temporary 
physiological  changes  of  relative  positions  due  to  the  postural 
changes  in  the  woman. 

Internal  Migration  of  the  ovum  is  the  passage  of  an  ovum 
from  one  tube  via  the  uterine  cavity  to  the  other  tube. 

It  is  much  more  difficult  to  prove  that  this  internal 
migration  actually  takes  place:  that  it  is  possible  and 
feasible  is  evident  from  these  facts.  The  journey  for  the 
ovum  from  one  uterine  ostium  of  the  tube,  across  the 
uterine  cavity,  to  the  other  uterine  ostium,  is  not  a  long 
journey;  for  the  uterine  cavity  transversely  (the  uterus  not 
being  at  the  time  enlarged,  because  it  is  not  pregnant)  has 
a  lesser  diameter  than  the  vertical  one,  which  latter  con- 
stitutes the  usual  length  of  journey  made  by  the  ovum  on 
its  passage  out  of  the  uterus,  and  in  placenta  praevia  cases; 

1  Pollock,  "  Trans.  Obstet.  Soc,"  1898,  p.  120. 

2  Glockner,  "  Journ.  Obst.  and  Gynec,"  vol.  i.  1902,  p.  99. 


96  THE  CAUSATION  OF  SEX  • 

so  that  if  it  is  capable  of  making  the  longer  one,  it  should 
not  be  unusual  for  it  to  sometimes  make  the  shorter  or  trans- 
verse journey. 

Richet  (quoted  by  Hart  and  Barbour'^)  gives  the  following 
as  the  measurements: 

Virgin.         Multipara. 

Vertical  diameter  of  cavity  of  uterus      i-8o  in.      2  44  in. 
Transverse    ,,  ,,  ,,  -60   ,,       1-24   „ 

— that  is  to  say,  the  journey  down  the  uterus  is  three  times 
as  far  in  the  virgin  as  across  the  uterus,  while  it  is  twice 
as  far  in  a  multipara.  Placenta  praevia  cases  prove  the 
complete  vertical  journey  of  the  ovum. 

Another  point  which  is  in  favour  of  the  occasional  internal 
migration  of  the  ovum  is  that  a  woman  lying  in  bed  on  her 
side  makes  the  transverse  diameter  of  her  uterine  cavity  (or 
shorter  journey)  into,  for  the  time  being,  a  vertical  diameter, 
so  that  gravity  may  help  the  passage  of  the  ovum  from  one 
uterine  Fallopian  opening  to  the  other. 

Kussmaul,  quoted  by  Play f air, ^  thinks  the  muscular 
contractions  of  the  uterus  may  work  the  ovum  across. 

There  are,  then,  two  explanations  of  those  cases  where 
a  male  foetus,  say,  is  found  in  the  left  Fallopian  tube  or 
left  horn  of  the  uterus,  the  corpus  luteum  being  in  the 
right  ovary. 

They  are  the  External  and  Internal  Migration  of  the 
Ovum,  both  of  which  evidently  occur,  though  the  external 
migration  is  more  easily  proved. 

Owing  to  the  two  horns  of  the  uterus  freely  joining  each 
other  in  the  body  of  the  uterus  in  the  mammaha,  forming 
the  uterus  bicornis  unicollis,  internal  migration  of  the  ovum 
is  very  often  seen,  the  fertilised  ova  being  washed  down  one 
or  other  cornu,  and  attaching  themselves  as  often  as  not 
in  the  opposite  horn.  This  I  have  known  to  occur  very 
often  in  sheep,  cats,  and  rabbits. 

We  therefore  see  that  the  presence  of  a  male  foetus  in 
the  left  Fallopian  tube  in  no  way  disproves  my  theory,  nor 
do  females  in  the  right  tube,  or  the  right  uterine  cornu  in 
the  mammalia. 

1  Hart  and  Barbour,  "  Manual  of  Gynaecology,"  2nd  ed.  p.  16. 

2  Playfair,  op.  cit.,  p.  194- 


CHAPTER  XIV 

PREGNANCY   IN   THE   MAMMALIA 

Pregnancy  in  mammals  differs  from  pregnancy  in  the 
human  female  from  the  fact  that  in  most  of  the  mammalia 
the  pregnancy  is  a  multiple  one. 

UTERINE  CORNUA 


FALLOPIAI 
UBE 

/I. 


VAGINA  UNOPENED 


Fig.  15. — Uterus  of  a  Sheep,  Dorsal  Aspect:  unopened. 
(From  nature.) 

The  chief  difference,  however,  is  due  to  the  two  anatomical 
facts  that  in  mammals — 

{a)  The  uterus  is  not  a  single-cavity-containing  organ, 
but  is  practically  bifid.  It  is  said  to  be  bicornuate — i.e.  to 
possess  two  horns  or  arm-like  processes.  These  join  each 
other  to  form  a  more  or  less  Y-shaped  cavity. 

Into  the  divergent  extremities  of  the  two  cornua  the 
Fallopian  tubes,  which  are  exceedingly  small  in  comparison 
to  the  cornua,  open. 

97  7 


98 


THE  CAUSATION  OF  SEX 


The  portion  of  the  uterus  formed  by  the  coalesced  ends 
of  the  two  cornua  forms  the  body,  and  terminates  in  the 
neck  or  cervix  of  the  uterus. 

(b)  The  uterus  so  lies  in  the  mammalian  abdominal  cavity 
that  when  the  animal  is  standing  on  all  four  feet  the  uterus 
lies  parallel  to  the  spinal  column — i.e.  is  horizontal — with, 
as  a  rule,  the  tubal  ends  of  the  cornua  at  a  slightly  lower 


UTERINE  CORNUA 


CAVITY  OF  LEFT  CORNU 


REFLECTED   FLAP   FROM 

BOTH  UTERINE  CORNUA. 

TO   SHOW   INTERIOR 


FALLOPIAN  TUBE  CUT 


INTER-CORNUAL  SEPTUM 
CAVITY  OF  RIGHT  CORNU 
CUT  EDGE   OF    UTERINE  CORNU 

CAVITY  OF   BODY  OF  UTERUS 
COMMON   TO   BOTH   CORNUA 


PORTION   OF  INTER-CORNUAL 
SEPTUM 


Fig.  15A. — Uterus  of  a  Sheep:  opened.     (From  nature.) 


level  in  the  abdomen  than  the  cervical  or  vaginal  end;  in 
fact,  as  Arthur  Johnstone,  of  Cincinnati,  puts  it: 

"  The  OS  uteri  of  the  horizontal  animal  points  upwards;  the  other 
end  of  the  uterus  points  downwards." 

It  will  thus  be  seen  that  a  great  difficulty  would  have 
occurred  in  emptying  the  uterus  had  the  mammalia  men- 
struated regularly. 

The  erect  posture  of  woman,  with  the  mouth  of  her  womb 
in  the  most  dependent  position,  must  facilitate  drainage 
away  of  the  menstrual  discharge;  so  that  only  vertical 
animals  really  menstruate. 


PREGNANCY  IN  THE  MAMMALIA  99 

The  horizontal  or  mammaUan  uterus,  too,  is  very  soft  and 
very  readily  bent,  and  does  not  easily  spring  back  into 
position,  as,  owing  to  its  hardness  and  elasticity,  does  the 
human  uterus. 

Physiologically,  too,  there  is  the  difference  that  in  the 
mammalia  coition  in  the  natural  state  practically  always 
ends  in  pregnancy;  sexual  congress  is  only  permitted  by 
the  female  at  those  times  when  pregnancy  will  result — 
i.e.  only  when  ova  are  already  provided  will  the  f empale 
permit  insemination. 

The  occasional  non-occurrence  of  pregnancy  in  the 
domesticated  mammalia — e.g.  mares,  cows,  etc. — when  put 
to  the  male  is  due  to  the  choosing  of  the  day  for  sexual 
congress  by  the  ignorant  groom  or  herdsman,  rather  than  its 
being  left  to  the  female  to  gratify  her  desire  when  she  pleases, 
and  when  she  instinctively  knows  that  pregnancy  will 
result.  Among  the  mammalia,  heat,  rut,  or  oestrus  is  the 
external  sign  that  ova  are  matured,  and  ready  for  im- 
pregnation. 

Farre  says : 

"  In  the  mammalia  the  periods  of  emission  of  ova  from  the  ovary 
and  their  passage  down  the  Fallopian  tube  are  undoubtedly  coin- 
cident with  oestrus  or  rut.  It  is  only  on  these  occasions  that  the 
female  manifests  an  instinctive  desire  for  copulation.  She  is  then 
said  to  be  in  heat.  The  condition  is  of  brief  duration ;  but  whatever 
be  its  duration,  it  is  the  only  period  during  which  the  female  can  be 
impregnated." 

Having  been  fertilised,  the  ova  or  oosperms  travel  down 
their  respective  tubes  (for  in  the  polytocous  mammalia — 
i.e.  those  which  bear  many  young — both  ovaries  ovulate 
at  the  same  time)  and  thus  reach  their  respective  cornua. 
where  they  usually  attach  themselves  and  develop;  others 
travel  farther,  even  into  the  opposite  cornu,  and  develop  there. 

We  are  quite  ignorant  as  to  what  determines  the  site  of 
attachment  of  the  fertilised  ovum.  Probably  movements 
of  the  fluid  in  the  uterine  cavity  are  largely  instrumental 
in  causing  the  fertilised  ovum  to  be  carried  to  a  distance 
before  attaching  itself,  aided  by  changes  in  the  posture  of 
the  animal.  And  we  are  not  in  a  position  to  deny  to  the  fer- 
tilised ovum  some  power  of  movement,  or  even  of  site  selection. 


100  THE  CAUSATION  OF  SEX 

Proof  that  the  fertihsed  ova  on  arrival  in  the  uterus 
travel  some  distance  before  being  attached  to  the  uterine 
wall  is  derived  from  the  fact,  as  Bischoff  pointed  out  long 
ago,  of  the  occurrence  of  the  foetus,  especially  in  cases  of 
single  pregnancy,  in  the  opposite  horn  of  the  uterus  to  the 
corpus-luteum-bearing  ovary. 

This  necessitates  a  journey  for  the  oosperm  down  its 
corresponding  cornu  into  the  body  of  the  uterus,  and  thence 
into  the  opposite  cornu.     Garrigties^  says: 

"  In  animals  it  has  been  proved  that  an  ovnni  can  migrate  from 
one  horn  of  a  bicornuate  uterus  to  the  other, " 

Another  explanation  of  this  occurrence,  especially  in 
cases  where  the  cornua  do  not  freely  intercommunicate,  is 
furnished  in  the  chapter  on  the  Migration  of  the  Ovum. 

However  many  ova  are  fertilised,  a  corresponding  number 
of  corpora  lutea  will  be  found  in  the  two  ovaries  together, 
and  they  will  equal  the  number  of  foetuses  found  present  in 
the  two  cornua. 

This  was  pointed  out  years  ago  by  Abernethy,^  who  said: 

"  If  in  any  animal — in  a  virgin  rabbit,  for  instance,  after  she  had 
taken  the  buck — you  find  four  or  five  young  ones,  you  would  find 
four  or  five  corpora  lutea." 

I  have  satisfied  myself  of  the  correctness  of  this  in  different 
animals — e.g.  cows,  sheep,  pigs,  rats,  mice,  cats,  and  rabbits. 
In  a  large  tame  pregnant  rabbit  I  examined  there  was  the 
unusual  number  of  fourteen  young  rabbits  in  the  two 
cornua,  and  there  was  a  corresponding  number  of  corpora 
lutea — viz.  six  corpora  lutea  in  the  right  ovary  and  eight 
corpora  lutea  in  the  left  ovary. 

That  the  body  of  the  mammalian  uterus  is  not  the  usual 
site  of  fertilisation  is  evident  from  the  presence  of  living 
spermatozoa  not  only  in  the  Fallopian  tubes,  but  even  on 
the  surface  of  the  ovaries  shortly  after  insemination. 

I  have  made  numerous  observations  of  the  sexes  of  the 
young  in  the  two  cornua,  and  these  confirm  the  opinion  that 

1  Garrigues,  "  Obstetrics,"  1902,  p.  13. 

2  Abernethy,  "  Lectures  on  Anatomy,  Surgery,  and  Pathology,"  1828, 
p.  422. 


Fig. 


-Pregnant  Uterus  of  a  Cow, 
Aspect. 


SEEN    FROM    THE    DORSAL 


From  a  photograph  of  the  Author's  specimen. 

Inter-cornual  Fold  and  Sulcus.  2.  Left  Comu  of  Uterus:  not  pregnant.  3.  Left  Fallopian 
Tube.  4.  Left  Ovary  opened:  no  Corpus  Luteum  therein.  5,  Cervix  Uteri  plugged  with 
Mucus.  6.  Male  Calf  partly  extracted  from  the  Right  Comu.  7.  Right  Comu  of  Uteras: 
pregnant.  8.  Right  Ovary  opened,  showing  large  bisected  Corpus  Luteum.  9.  Sound 
passed  into  Bladder.  10.  Rod  passed  along  Vagina  up  to  the  Cervix.  11.  Vagina  opened, 
showing  the  Cervix. 


To  face  page  loi.] 


PREGNANCY  IN  THE  MAMMALIA  loi 

fertilisation  takes  place  in  the  tubes,  and  the  fertilised  ova 
often  wander  widely  before  attaching  themselves  to  the 
cornual  wall  and  developing. 

Thus  in  the  monotocous  animal,  though  it  is  most  usual 
to  find  the  young  animal  in  the  cornu  corresponding  to  the 
corpus-luteum-containing  ovary — i.e.  the  ovary  which 
yielded  the  ovum  that  was  fertihsed — this  is  not  always  the 
case,  as  I  shall  shortly  show.  The  opposite  or  non-pregnant 
cornu  undergoes  sympathetic  hypertrophy,  and  a  decidua 
forms  in  its  interior. 

Early  in  March  1902  I  opened  the  pregnant  uterus  of 
a  cow,  usually  a  monotocous  animal,  though  not  always. 
There  was  no  corpus  luteum  in  the  left  ovary;  there  was  a 
large  typical  corpus  luteum  in  the  right  ovary,  so  I  foretold 
a  hull  calf  before  I  opened  the  actual  uterus.  The  left 
cornu  was  not  pregnant;  the  right  cornu  was  occupied  by 
a  male  or  bull  calf  (see  Fig.  16).  The  left  cornu  could  be 
easily  emptied  of  its  fluid  contents,  etc.,  via  the  right  cornu, 
showing  the  very  free  communication  between  the  cornua. 

I  have  also  found  the  same  occur  on  the  other  side  in 
other  cows,  a  female  calf  in  the  left  cornu  being  found  with 
the  corpus  luteum  in  the  left  ovary.  I  have  found  the  same 
thing,  too,  in  sheep. 

In  other  cases,  as  I  have  said,  the  fatal  animal  is  in  the 
opposite  cornu  to  the  corpus  luteum,  showing,  in  those  cases 
where  the  cornu  communicates,  a  journey  down  one  cornu 
through  the  cervical  portion  of  the  uterus  and  so  into  the 
opposite  cornu. 

Thus  in  a  sheep  I  have  found  a  female  lamb  in  the  right 
cornu,  with  the  only  corpus  luteum  in  the  left  ovary,  and 
I  have  seen  many  similar  cases  in  cows. 

This  condition  of  foetus  in  one  horn  and  corpus  luteum  in 
the  opposite  ovary  occurs  also  in  women,  if  the  uterus  be 
double  or  bicornuate,  as  in  the  following  case : 

Dr.  J.  R.  Ratcliffe^  reports  a  case  of  pregnant  uterus  bicornis. 

"  The  left  horn  contained  the  foetus.  The  right  ovary  (that  on 
the  opposite  side  to  the  pregnant  horn)  showed  a  true  corpus  luteum; 
none  in  the  left  ovary.  The  cervix  was  short  and  broad,  only  a 
quarter  of  an  inch  deep.     The  os  externum  is  single." 

1  "  Trans.  Obstet.  Soc,"  1892,  vol.  xxxiv.  p.  469. 


102 


THE  CAUSATION  OF  SEX 


The  sex  of  the  foetus,  which  was  between  the  second  and 
third  month  of  gestation,  is  not  given. 

The  committee  appointed  to  report  on  this  specimen  say : 

"  The  ovum  from  the  right  ovary  may  have  been  washed  up  the 
left  cornu  just  as  it  left  the  right  cornu  immediately  above  the  os 
externum,  but  from  the  shallowness  of  the  os  this  seems  hardly 
probable." 

FEMALE    LAMBS 


LEFT    OVARY   BISECTED.    SHOWING 
TWO   DISTINCT  CORPORA  LUTEA 


Fig.  17, — The  Pregnant  Uterus  of  a  Sheep,  Dorsal  View. 
(Original  drawing  from  nature.) 

There  is  no  corpus  luteum  in  the  right  ovary;  both  uterine  comua  are  pregnant  with  a  female 
lamb,  and  the  left  ovary  contains  two  well-marked  distinct  corpora  lutea,  because  it  had 
provided  both  ova. 


Why  this  shallow  cervix,  which  was  a  quarter  of  an  inch 
deep,  should  be  thought  an  obstacle  to  an  ovum  of  at  most 
one  hundredth  of  an  inch  diameter  I  cannot  understand; 
the  more  so  when  we  recall  that  it  has  already  travelled 
down  the  Fallopian  tube,  whose  diameter  is  infinitely  less 
than  a  quarter  of  an  inch,  the  depth  of  the  cervix. 


PREGNANCY  IN  THE  MAMMALIA  103 

In  the  polytocous  animals,  or  those  which  bear  multiple 
offspring,  we  find  that  one  cornu  is  very  rarely  empty  if 
there  be  more  than  one  embryo — that  is,  it  is  rare  to  find 
two  or  more  foetuses  in  one  cornu  and  none  in  the  opposite 
cornu. 

If  an  animal  have  only  two  foetuses  in  the  uterus,  one 
will  usually  occupy  each  cornu  regardless  of  its  sex;  thus 
in  a  pregnant  sheep  I  opened,  I  found  the  right  ovary  small, 
with  no  corpus  luteum.  The  left  ovary  contained  two  quite 
distinct  threepenny-piece-sized  corpora  lutea;  though,  as 
both  horns  were  manifestly  pregnant,  I  diagnosed  before 
opening  them  a  female  lamb  in  each  horn,  and  such  they 
turned  out  to  be  when  I  slit  them  open. 

I  may  add  that  there  could  be  no  question  as  to  the  sex, 
for  they  were  covered  in  wool  and  so  sufficiently  developed 
to  be  able  to  tell  by  inspection;  further,  in  most  cases  I 
opened  the  foetuses  and  found  the  uterus,  etc.,  or  else  the 
male  organs. 

In  another  sheep  I  fo'und  a  male  lamb  in  the  right  cornu 
and  a  female  in  the  left,  with  a  corpus  luteum  in  each  ovary. 

In  those  animals,  such  as  pigs,  cats,  rabbits,  mice,  which 
I  have  examined,  whose  offspring  are  truly  multiple,  the 
foetuses  are  mixed  up  in  the  two  cornua;  but,  as  I  have 
before  pointed  out,  the  ovaries  contain  between  them  a 
corresponding  number  of  corpora  lutea,  both  individually 
as  regards  sex  and  collectively  as  regards  numbers. 

Thus,  in  a  pregnant  cat  there  were  four  kittens,  three 
females  and  one  male ;  three  corpora  lutea  in  left  ovary,  one 
in  the  right  ovary.  They  were  lodged  thus :  two  females  in 
the  left  cornu,  and  one  female  and  one  male  in  the  right. 

In  February  1902  I  examined  the  young  pigs  in  a  sow's 
cornua,  and  found  that,  like  the  young  of  cats,  rabbits,  mice, 
etc.,  they  are  mixed  as  regards  sex  in  the  cornua. 

From  some  experimental  operations  by  Prof.  Leonard  Don- 
caster^  on  one  of  the  rodentia — to  wit,  the  multiple  off- 
spring bearing  rat — it  would  appear  that  removal  of  one 
of  her  ovaries  does  not  prevent  a  rat  having  young  of  both 
sexes.  We  have,  however,  no  evidence  that  what  occurs 
in   the   polytocous  animals — especially  these   members   of 

^  L.  Doncaster,  "  Journal  of  Genetics^"  Nov.  1910, 


104  THE  CAUSATION  OF  SEX 

the  mammalia  whose  chief  characteristic  is  their  small 
size  and  prolificacy — must  equally  apply  to  monotocous 
woman.  It  is  to  be  regretted  the  operation  was  not  tried 
on  one  of  the  monotocous  anthropoid  apes. 

Sir  William  Gowers  has  said  in  somewhat  similar  circum- 
stances, "I  do  question  an  inference  from  guinea-pigs 
to  men,"  as  the  writer  does  from  rats  to  women.  It  is 
certainly  a  "  far  cry  "  from  rats  to  women. 

Among  the  specimens  at  the  Royal  College  of  Surgeons 
Museum,  the  following  show  the  way  in  which  the  pro- 
spective family  is  distributed  in  the  cornua: 

Specimen  No.  3576. — Pregnant  hedgehog:  four  foetuses 
in  right  cornu,  two  in  the  left  cornu. 

Specimen  No.  3566A. — Pregnant  cat:  two  foetuses  in 
each  uterine  horn. 

Specimen  No.  3574. — Pregnant  mole:  three  foetuses  in 
right,  two  in  the  left  cornu. 

Specimen  No.  3469A. — Pregnant  mouse:  four  foetuses  in 
each  uterine  cornu. 


CHAPTER  XV 

WHY  MORE  BOYS  ARE  BORN  THAN  GIRLS 

Though  there  is  no  uniform  proportion  or  numerical 
relation  between  the  numbers  of  male  and  female  children 
born  to  any  two  parents,  i.e.  in  any  one  individual  family, 
yet  there  is  a  very  definite  or  normal  numerical  relation 
between  the  sexes  at  birth  on  taking  the  average  of  a  country 
or  several  countries,  the  proportion  being  io6  male  to  lOO 
female  children. 

That  this  excess  of  male  births  is  not  accidental  is  evident 
by  its  universality. 

As  Havelock  Ellis^  says: 

"  There  are  more  boys  than  girls  born  among  the  Germans, 
French,  EngHsh,  and  most  civiUsed  European  races  "; 

the  slight  variation  in  the  proportions  as  given  for  the 
different  countries  not  affecting  the  average  proportion  of 
io6  males  to  lOO  feniales  for  all  countries.  The  pro- 
portion is  reputed  to  be  in  excess  of  these  figures  in  those 
countries  only — e.g.  Spain,  Roumania,  (ireece — where  we 
should  least  expect  birth  certification  and  registration  to 
be  carefully  and  accurately  carried  out.  This  fact  of  the 
excess  of  male  births  over  female  births  has  been  noticed 
and  recorded  for  over  two  hundred  years,  so  that  its  ex- 
planation must  apply  to  that  time  also. 

Why  it  is  imperative  that  Nature  should  produce  more 
boys  than  girls,  is  evidently  due  to  the  necessity  that  exists 
to  compensate  for  the  greater  mortality  of  males. 

This  excessive  male  mortality,  as  we  shall  presently  see, 
does  not  only  occur  at  birth. 

At  birth  the  difficulties  and  dangers  of  parturition,  and 
the  consequent  higher  foetal  mortality,  are  increased  by 

^  H.  Ellis-,  "  Man  and  Woman,"  1904,  p.  429. 
105 


io6  THE  CAUSATION  OF  SEX 

the  larger  size  and  greater  weight  of  the  male  foetus  corr- 
pared  to  the  female. 

This  applies  not  only  to  the  boy's  head,  which,  as  a  rule, 
is  larger  than  a  girl's,  but  usually  to  the  whole  body  also, 
which  necessarily  undergoes  greater  compression  in  its 
passage  through  the  genital  canal;  hence  we  find  that  the 
proportion  of  still-born  boys  is  very  much  larger  than  that 
of  still-born  girls,  the  ratio  being  138  still-born  boys  to  100 
still-born  girls.  So  that  we  have  not  only  more  living  males 
born  than  females,  but  also  a  still  larger  proportion  of  dead 
full-time  males  to  dead  females.  Abortions  and  premature 
births  are  also  more  often  males  than  females,  so  that  male 
conceptions  exceed  female  conceptions,  the  ratio  being  about 
no  male  conceptions  to  100  female. 

Even  after  birth  there  is,  especially  during  the  first  year  of 
life,  a  much  greater  liability  for  the  male  infant  to  die — so 
much  so  that  although,  as  we  have  seen,  more  boys  are 
born  than  girls,  the  proportions  are  reduced  to  almost  even 
terms  by  the  end  of  the  first  year,  owing  to  this  greater 
male  mortality. 

Drs.  Pinard  and  Magnan  found,  from  the  examination 
of  over  52,000  confinements  in  the  Clinique  Baudelocque, 
that  during  gestation  the  mortality  among  boys  was  scarcely 
in  excess  of  that  of  girls — viz.,  618  boys  to  611  girls.  So 
that  it  is  "only  during  and  after  birth  that  more  boys  die, 
the  evident  penalty  of  increased  size  and  weight,  and  the 
consequential  compression. 

During  the  first  four  years  of  life,  in  a  gradually  diminish- 
ing degree,  the  mortality  among  males  still  exceeds  that 
among  females;  and  this  is  the  more  remarkable  when  we 
recall  that  the  management  of  the  two  sexes  does  not 
materially  differ — they  are  dressed  practically  identically, 
and  receive  the  same  food. 

Dr.  Harry  Campbell^  states  that  the  proportion  of  male 
deaths  to  female  for  the  first  five  years  of  life  is  69-5  male  to 
597  female  per  thousand.  He  ascribes  it  to  "  an  innate 
tenacity  of  Hfe  on  the  part  of  the  female."  Dr.  C.  W. 
Saleehy  says  it  is  "  the  inherent  vitaHty  of  woman  which  is 

1  H.  Campbell,  "  Differences  in  the  Nervous  Organisation  of  Man  and 
Woman,"  1891,  pp.  123-5, 


WHY  MORE  BOYS  ARE  BORN  THAN  GIRLS     107 

superior  to  man's,"  and  this,  he  points  out,  is  a  provision 
by  Nature  for  the  strain  and  risks  of  maternity.  For 
some  interesting  particulars  of  this  higher  male  mortality 
see  also  Havelock  Ellis,  "  Man  and  Woman,"  chap,  xvii., 
4th  ed.,  1904. 

The  environment  of  adult  men  and  women  differs  con- 
siderably; the  woman's  hfe  is  passed  essentially  within 
doors,  the  man's  is  more  out  of  doors,  and  this  very  condi- 
tion of  Ufe  and  work  in  the  open  is  responsible  for  some  of 
the  deaths  to  which  women  are  not  so  liable. 

Lads  and  men,  both  in  their  pleasures  and  in  their  occu- 
pations, run  many  risks,  and  meet  with  not  only  fatal 
accidents,  but  with  fatal  illnesses  also,  and  thus  help  to 
swell  the  adult  male  mortality. 

One  cannot,  however,  fail  to  agree  with  Dr.  Harry  Camp- 
bell^ that— 

"  The  part  played  by  an  unfavourable  environment  in  causing 
the  proportionately  greater  mortality  of  the  male  sex  has  been  much 
exaggerated." 

When,  therefore,  to  the  greater  male  infantile  mortality 
we  add  the  greater  adult  male  mortality,  it  becomes 
abundantly  evident  that  it  was  essential  for  Nature  to 
produce  more  boys  than  girls  to  counteract  the  greater 
male  mortality. 

The  greater  male  birth-rate  is,  however,  more  than 
counterbalanced  by  the  greater  male  mortality,  so  that 
among  adults  the  number  of  living  females  exceeds  the 
males.  In  1901  over  eighteen  thousand  more  males  than 
females  were  born  in  England  and  Wales,  but  over  twenty 
thousand  fewer  females  than  males  died  during  the  same 
time.  So  great  has  become  this  excess  of  women  over  men 
that  the  proportion  now  stands  at  107  living  women  to 
100  men,  or  a  total  majority  in  these  islands  of  1,082,000 
women  up  to  the  year  1901. 

Having  considered  the  reasons  why  more  boys  should  be 
born  than  girls,  it  remains  to  see  how  this  excess  of  male 
births  over  the  female  is  brought  about. 

^  H.  Campbell,  op.  cit.,  p.  122. 


io8  THE  CAUSATION  OF  SEX 

How,  then,  does  Nature  insure  the  production  of  more 
boys  than  girls  ? 

This  simple-looking  question  has  always  been  one  of  the 
most  difficult  ones  to  explain  by  any  of  the  theories  hitherto 
put  forward  to  elucidate  the  cause  of  sex,  and  the  means  by 
which  this  excess  of  male  births  is  brought  about  has 
evaded  all  theorists.  It  can  be  readily  explained  by  the 
theory  I  set  forth. 

It  is  solved  by  the  evident  fact  that  in  order  to  produce 
more  males,  or  boys,  it  will  first  be  necessary  to  provide 
more  male  ova;  but,  as  I  have  already  shown,  the  male 
ova  come  only  from  the  right  ovary,  hence  it  is  essential  to 
produce  more  right-sided  than  left-sided  ova.  This,  then, 
is  brought  about  by  increasing  the  area  of  the  right  ovary 
as  compared  to  the  left,  so  that  more  ova  are  produced  by 
the  larger  right  or  male  ovary  than  by  the  opposite  or 
smaller  left  ovary. 

That  the  ovaries  are  not  usually  the  same  size  I  have 
already  mentioned  in  the  chapter  on  their  anatomy,  the 
right  ovary  being  a  little  larger  than  the  left. 

This  actual  anatomical  fact  has  been  very  slowly  recog- 
nised by  British  writers,  for  unfortunately,  in  discussing  the 
anatomy  of  the  ovaries,  they  are  generally  spoken  of  in  the 
singular,  and  their  respective  size  is  not  given. 

That  the  right  ovary  is  the  larger  of  the  two  ovaries  is 
definitely  stated  by  the  following  authors: 

William  Anderson^  says,  "  The  right  (ovary)  is  usually 
a  little  larger  than  the  left." 

Clarence  Webster'^  says,  "  The  right  ovary  is  larger  than 
the  left." 

George  A,  Piersol^ :  "The  right  ovary  being  commonly 
slightly  heavier  and  larger  than  the  left  ovary." 

Parvin^  :  "  The  right  ovary  is  usually  somewhat  larger 
than  the  left." 

1  Anderson  in  "  Henry  Morris'  Treatise  on  Human  Anatomy,"  3rd  ed. 
igo2,  p.  1 106. 

2  C.  Webster,  "  Diseases  of  Women,"  1898. 

3  Piersol  in  Norris  and  Dickinson,  op.  cit.,  p.  57. 

*  Parvin,  "  Science  and  Art  of  Obstetrics,"  1895,  3rd  ed.,  p.  76. 


WHY  MORE  BOYS  ARE  BORN  THAN  GH^LS    109 

Bonamy  and  Beau^  show  in  Fig.  i,  Plate  72,  in  a  young 
virgin  woman  who  died  in  the  intermenstrual  period,  the  right 
ovary  considerably  larger  than  the  left. 

Berry  Hart^  shows  the  right  ovary  about  a  third  larger 
than  the  left. 

In  order  to  further  satisfy  myself  of  the  correctness  of 
this  fact,  I  have  inspected  the  specimens  at  the  Royal 
College  of  Surgeons  Museum,  and  find  that  specimens 
Nos.  293,  296,  297,  in  the  anatomical  series,  and  specimens 
Nos.  2818,  3619A  in  the  physiological  series,  prove  it 
to  be  true;  but  one  specimen,  No.  294,  of  the  "Uterus 
and  appendages  from  an  old  woman  who  had  borne 
children,"  shows  the  left  ovary,  a  trifle  only,  larger  than 
the  right. 

In  several  autopsies  I  have  made  in  general  practice  on 
women  in  the  reproductive  period  of  life  I  have  found  the 
right  ovary  larger  than  the  left,  and  the  increased  size  was 
not  due  to  the  increased  size  of  an  ovary  incidental  to 
the  presence  of  the  menstrual  period,  nor  was  it  due  to  the 
presence  of  a  corpus  luteum  of  pregnancy. 

Further,  I  have  noted  the  relative  size  of  the  ovaries  while 
watching  others  perform  such  operations  as  hysteropexy 
for  conditions  which  (Jo  not  imply  disease  of  the  ovaries 
themselves.  These  cases  have  also  proved  that  the  right 
ovary  is  the  larger  of  the  two. 

Granting,  therefore,  that  the  right  ovary  is  slightly 
larger  than  the  left  ovary,  we  can  correctly  attribute  the 
fact  that  more  boys  are  born  than  girls  to  this  other  fact — 
that  the  area  of  ovarian  tissue  capable  of  producing  right- 
sided  or  male  ova  is  greater  in  extent  than  is  the  left  ovary, 
and  thus  does  Nature  secure  the  production  of  more  male 
ova  than  female  ova. 

That  this  is  the  correct  solution  of  this  vexed  question, 
why  more  boys  are  born  than  girls,  is  confirmed  by  the 
equally  convincing  fact  that  twin  boys  are  similarly  much 
more  numerous  than  twin  girls ;  for  manifestly  the  probability 
of  providing  two  distinct  ova  at  the  same  time  by  the  right 

1  Bonamy  and  Beau,  "  Anatomy  of  the  Human  Body,"  Paris,  part  iii., 
1850,  Plate  72. 

2  Hart,  "  Atlas  of  Female  Pelvic  Anatomy,"  1S84,  Plate  vi.,  lig.  4,  p.  10. 


no  THE  CAUSATION  OF  SEX 

ovary  is  much  increased  by  enlarging  the  size  of  that  right 
ovary,  over  the  ovary  of  the  opposite  or  left  side. 

Thus  Veit,^  out  of  150,000  cases  of  twins,  found  that 
50,000  cases  were  both  boys,  and  46,000  cases  were  both  girls. 

Galabin,^  besides  quoting  Veit's  figures,  also  gives,  from 
the  Guy's  Hospital  Maternity  Charity,  the  percentages  as 
38  per  cent,  both  boys,  28  per  cent,  both  girls. 

Porter  Mathew^  gives  the  percentages  as  58  per  cent,  both 
boys,  16  per  cent,  both  girls. 

Rumpe,  quoted  by  Jewett,  gives  "31  cases  both  boys, 
16  both  girls." 

Spiegelberg,"^  too,  states  that  twin  boys  occur  more  often, 
for  "  two  females  are  rarest." 

Parvin^  also  says  that  "  twin  males  predominate  over 
females." 

Garrigues^  says:  "  The  rarest  combination  is  that  of  two 
females." 

Jewett'^  says:  "The  proportion  of  twin  males  is  largely 
in  excess." 

Not  only  does  Nature  thus  relatively  increase  the  number 
of  male  or  right-sided  ova  she  produces,  but  she  renders  their 
fertilisation  more  probable,  by  so  placing  the  right  cornu  of 
the  uterus,  the  right  Fallopian  tube,  and  the  right  ovary, 
that  access  to  them  by  the  spermatozoa  is  actually  easier 
than  to  the  opposite  or  left  side.  Further,  the  right  tube 
is  larger  than  the  left,  so  that  the  passage  of  the  spermatozoa 
is  facilitated  (see  Figs.  3  and  18). 

Thus  Spiegelberg,^  Play f air, ^  and  Parvin^^  agree  that  "a 
slight  rotation  occurs  by  which  the  left  side  (of  the  uterus)  is 
thrown  towards  the  front,  and  the  right  (side)  backwards. "  ^^ 
Consequently  the  right  cornu  uteri,  tube,  and  ovary  lie  on  a 

1  Veil,  quoted  in  Lusk's  "  Midwifery,"  1889,  p.  230.  j, 

2  Galabin's  "  Midwifery,"  1900. 

3  Porter  Mathew,  "  Clinical  Observations  on  Two  Thousand  Obstetric 
Cases,"  1898,  p.  35. 

4  Spiegelberg,  op.  cit.,  p.  271. 

5  Parvin,  op.  cit.,  p.  165. 

6  Garrigues,  "  Science  and  Art  of  Obstetrics,"  1902,  p.  259. 

7  Jewett,  "  Practice  of  Obstetrics,"  1907,  p.  316. 

8  Spiegelberg,  op.  cit.,  p.  32. 

8  Playfair,  op.  cit.,  p.  S3-  ^°  Parvin,  op.  cit.,  p.  71. 

11  See  also  Gerrish  in  the  chapter  on  "  Anatomy,"  and  Tweedy  and 
Wrench,  "  Practical  Midwifery,"  1908,  p.  248. 


WHY  MORE  BOYS  ARE  BORN  THAN  GIRLS     iii 

lower  level  in  the  pelvis  than  do  those  of  the  left  side  when 
the  woman  is  lying  on  her  back,  and  thus  access  of  semen  to 
the  right  tube  is  favoured.  This  is  still  further  facilitated 
by  the  fact  that  more  women  invariably  sleep  on  the  right 
side  than  on  the  left — so  much  so,  that  Spiegelberg  even 
considered  the  more  usual  right  lateral  posture  for  sleep  as 
responsible  for  the  inclination  of  the  uterus  to  the  right  side 
of  the  body. 

From  inquiries  I  have  made  of  many  scores,  of  married 
women  especially,  I  found  the  majority  do  sleep  on  their 
right  side.  Further,  I  find  this  habit  is  due  to  the  ana- 
tomical fact  of  the  presence  of  the  heart  on  the  left  side ;  for 
in  lying  on  the  left  side  a  woman's  left  breast  is  pressed 
upon  the  region  of  her  heart,  and  its  action  is  not  only 
accelerated,  but  it  becomes  very  distinctly  audible  to  her — 
in  fact,  palpitation  disturbs  her  rest,  and  this  she  avoids 
instinctively  by  turning  on  to  her  other  side.  Here  the 
pressure  of  the  right  breast  on  the  chest  wall  has  necessarily 
no  disturbing  effect.  1  have  further  proved  this  by  noting 
that  women  with  ill-developed  breasts  sleep  on  either  side 
at  will;  a  woman  with  well-developed  breasts  sleeps  nearly 
always  on  her  right  side.  Some  of  the  semen  usually  enters 
the  womb  directly  during  coition,  it  being  drawn  in  by  a 
suction-like  action  on  the  part  of  the  uterus.  Were  it  not 
so,  a  mercurial  vaginal  injection  just  after  coitus  should 
invariably  prevent  pregnancy,  which  it  does  not.  Owing, 
however,  to  the  motility  of  the  spermatozoa,  this  action 
of  the  uterus  is  not  absolutely  essential  to  successful  fertili- 
sation. 

H  the  Fallopian  tubes  are  to  be  looked  upon  as  receptacles 
for  the  semen  (see  the  chapter  on  "  Fertilisation"),  it  is 
evident  that  the  tube  which  usually  lies  on  a  lower  level 
is  the  one  into  which  gravity,  acting  soon  after  coitus,  will 
help  to  carry  most  of  the  semen;  and  the  larger  right  will 
contain  more. 

Although  the  spermatozoa  are  known  to  travel  greatly 
through  their  own  motility,  yet  this  more  dependent  position 
of  the  uterine  opening  of  the  right  Fallopian  tube  must 
to  some  extent  help  to  secure  the  entrance  into  the  right 
tube  of  a  greater  amount  of  semen,  and  thus  the  fertilisation 


112  THE  CAUSATION  OF  SEX 

of  the  right-sided  ova  is  rendered  more  probable.  On  the 
other  hand,  women  who  sleep  chiefly  on  the  left  side  must 
render  the  access  of  semen  to  the  right  Fallopian  tube  more 
diflftcult,  though  of  course,  owing  to  the  motility  of  the 
spermatozoa,  far  from  impossible. 

This  greater  accessibility  of  the  right  Fallopian  tube  to 
the  semen  must,  of  course,  only  rank  as  a  contributory 
reason  for  more  boys  being  born  than  girls ;  the  chief  reason 
being,  as  we  have  seen,  that  more  male  than  female  ova 
are  produced. 

The  fact  that  the  male  birth-rate  among  Jews  of  all 
nations  is  higher  than  the  male  birth-rate  among  Christians 
— Rauber  gives  the  figures  as  107-6  male  Jews  to  106-4  male 
Christians— is  due  entirely  to  religious  and  social  reasons, 
and  has  nothing  to  do  with  the  prohibition  of  sexual  con- 
gress till  a  week  has  elapsed  after  the  cessation  of  a  menstrual 
period. 

The  Jewish  religion  very  strongly  condemns — 

{a)  The  artificial  prevention  of  pregnancy. 
(6)  The  procuring  of  abortion. 

(c)  The  taking  of  drugs  with  the  intention  of  inducing 
miscarriage. 

We  know  that  women  more  readily  abort  and  miscarry 
with  male  children;  hence  whatever  prevents  abortion  or 
miscarriage  leads  to  an  increased  number  of  boys  being  born. 

The  Jewish  women,  too,  are  more  zealously  taught  the 
rearing  of  children  after  their  birth,  so  that  with  greater 
care  more  male  infants  are  reared  than  is  the  case  among 
Christian  women. 

And,  again,  infanticide  amongst  the  Jews  is  almost 
unknown. 

The  only  exception  to  the  usual  greater  birth-rate  of 
males  to  females  of  106  to  100  is  found  in  illegitimate 
children. 

We  find  that  the  percentage  of  illegitimate  boys  born  to 
illegitimate  girls  is  reduced  to  103  to  100 — a  difference  of  3 
per  cent.    More  girls  are  thus  born  relatively,  not  absolutely. 

This  birth  of  a  greater  number  of  illegitimate  female 
children  applies  chiefly  to  young  women  and  their  first 


WHY  MORE  BOYS  ARE  BORN  THAN  GIRLS      113 

child — the  result  of  indiscriminate  insemination.  It  is  not 
seen  in  those  young  women  who  have  more  than  one  ille- 
gitimate child,  neither  is  it  found  among  the  children  born 
of  people  "  living  together,"  but  not  actually  legally  or 
clerically  married. 

Illegitimacy  is  undoubtedly  the  chief  cause  of  criminal 
still-birth,  and  most  authorities  put  the  chances  of  an 
illegitimate  child  being  "  still-born,"  when  compared  with 
the  legitimate,  as  about  2  to  i.  Bertillon  puts  it  as  193  to 
100. 

As  a  rule  in  first  labours,  i  child  in  11  is  still-born,  whereas 
in  other  labours  only  i  in  32  is  born  dead. 

In  this  connection  it  is  curious  to  note  that,  while  Bertillon 
affirms  that  first  children  are  more  likely  to  be  males, 
Schenk  states  just  the  opposite — that  among  the  first-born 
there  are  a  greater  number  of  females. 

Two  important  points  must  be  borne  in  mind  when  we 
consider  this  greater  relative  birth-rate  of  illegitimate  girls. 

First.  We  must  not  forget  that  in  unmarried  women 
very  numerous  attempts  to  procure  abortion  are  made,  and 
that  women  abort  and  miscarry  with  a  male  child  more 
often  and  more  readily  than  with  a  female. 

Hence,  abortion  being  more  readily  induced  if  the  embryo 
be  a  male,  it  follows  that  if  pregnancy  is  not  thus  interrupted 
a  female  is  more  likely  to  be  born. 

Secondly.  If  pregnancy  proceed  naturally,  the  careless 
attention  at  the  hands  of  old  untrained  women  which  the 
majority  of  these  single  women  receive  during  the  actual 
confinement,  amounting  almost  to  criminal  neglect  in  the 
delivery  of  their  infants,  leads  to  the  larger-headed  male 
child  not  being  helped  into  the  world  as  he  probably  would 
be  were  his  mother  married.  Therefore  he  is  more  likely 
to  be  born  dead,  and  so  is  not  registered. 

It  is  possible  to  delay  the  birth,  or  to  omit  to  deliver  or 
to  tie  the  cord  quickly  enough  for  the  child  to  be  alive — 
sins  of  omission.  There  are  also  sins  of  commission  I  need 
not  allude  to. 

On  the  other  hand,  the  smaller  female  infant  slips  more 
readily  into  the  world,  and  hence  we  get  a  relatively  larger 
number  of  girls  born  illegitimately. 

8 


114  THE  CAUSATION  OF  SEX 

As  the  law  neither  required  the  registration  of  the  birth 
of  children  born  dead,  nor  a  medical  certificate  of  the  cause 
of  the  still-birth,  many  so-called  still-born  children  were  not 
really  so,  but  came  alive  into  the  world,  and  died  of  neglect, 
exposure,  suffocation,  or  other  illegal  means. 

The  Registrar-General's  report  for  1907  shows^  that — 
"In  thirty  years  the  birth-rate  of  illegitimates  has  declined 
from  144  per  1,000  unmarried  or  widowed  females  of  pro- 
creative  age  in  1878,  to  7-8  per  1,000  in  1907." 

If  full  details  and  statistics  of  the  sex  of  illegitimate 
conceptions,  not  live  births  only,  could  be  procured,  it  is 
very  doubtful  if  they  would  show  this  greater  proportion 
of  females. 

^  Cf.  "  The  Hospital,"  April  24,  1909,  p.  92. 


CHAPTER  XVI 

THE  INFLUENCE  OF  LATERAL  DECUBITUS 
ON  SEX  DETERMINATION 

It  is  difficult  to  trace  back  to  its  origin  the  belief  in  the 
influence  of  lateral  decumbency  on  sex  determination. 

The  theories  which  have  been  advanced  as  to  the  influence 
of  a  lateral  posture  on  the  causation  of  sex  take  three  more 
or  less  distinct  forms. 

The  first — I  mention  only  to  discredit  it — is  that  sex  is 
dependent  on  the  woman  lying  on  one  side  "  at  the  time  of 
coition." 

This  contention  is  manifestly  absurd,  as  a  lateral  position 
is  neither  normal  nor  even  common. 

A  second  theory,  first  broached  in  the  "Lancet,"^  was 
that  sex  depended"  on  which  side  you  habitually  slept  of 
your  wife:  if  on  the  left  side,  you  beget  girls;  if  on  the  right 
side,  boys  are  born. 

In  answer  to  this  the  editor  of  the  "  Lancet  "  asked,  How 
is  the  variation  of  sex  in  the  same  family  to  be  accounted 
for  ?  while  I  ask.  Whence  come  boy  and  girl  twins  ?  and 
What  settles  the  sex  of  the  children  whose  fathers  and  mothers 
did  not  sleep  together  at  all  ? 

The  third  idea  is  of  great  antiquity,  and  has  obtained  wide 
notoriety  and  belief. 

It  is  that  a  woman  must  turn  on  to  her  right  side  directly 
after  coition  for  a  male  pregnancy  to  result,  or  on  to  her  left 
side  directly  after,  to  insure  giving  birth  to  a  girl. 

This  theory  was  certainly  known  to  Avicenna,  a  physician 
living  in  Ispahan  in  the  tenth  century ;  and  Albertus  Magnus, 
in  1582,  knew  of  it  and  quoted  it. 

Millot,  a  French  doctor,  writing  in  1816,  also  supported 
the  idea,  and  further  ascribed  boys  to  fertilisation  of  the 

^  "  Lancet,"  1870,  vol.  i.,  p.  608. 
"5 


ii6 


THE  CAUSATION  OF  SEX 


ova  from  the  right  ovary,  and  girls  to  fertilised  left  ova; 
but,  unlike  my  theory,  he  ascribed  to  the  father  his  share 
in  sex  causation. 

This  theory  of  turning  on  to  one  or  other  side  after  coition, 
to  produce  the  sexed  child  desired,  is  credited  in  many  parts 

CUT  ACROSS 


Fig.  i8. — Posterior  View  of  Uterus  and  Ovaries,  with  the  Folds 
OF  Peritoneum  forming  the  Broad  Ligaments,  etc.  (Modified 
from  Dickinson  and  Hodge.) 

The  figure  shows  the  uterus  lying  more  in  the  right  half  of  the  pelvis,  its  anterior  surface  facing 
more  to  the  right,  and  the  right  tube  and  ovary  carried  backwards.  The  back  of  the  pelvis, 
etc.,  has  been  removed. 

of  the  country  to  this  day,  so  that  it  may  be  called  the 
popular  view.  It  has  been  advocated  without  in  any  way 
being  aware  of  or  appreciating  the  anatomical  conditions 
which  secure  for  it  at  least  some  element  of  truth,  as  well 
as  prospect  of  success;  for  it  is  only  recently  that  the 
Fallopian  tube  has  been  acknowledged  to  be  the  most  usual 
site  of  fertilisation. 


LATERAL  DECUBITUS  AND  SEX  CAUSATION     117 

I  have  already  alluded  in  Chapter  XV.  to  the  fact  that 
the  majority  of  women  sleep  on  their  right  side,  and  that 
to  this  fact  of  lying  chiefly  on  the  right  side  Spiegelberg 
(cf.  p.  7)  credited  the  usual  position  of  the  uterus  in  the 
pelvis ;  for,  owing  to  gravity,  the  weight  of  the  uterus  would 
cause  it  to  fall  over  towards  the  lower  level  of  the  right  side. 
It  must  not  be  forgotten,  too,  that  the  presence  of  the  rectum 
also  helps  to  press  the  uterus  more  over  to  the  right  side. 

Further,  I  have  pointed  out  that  this  position  of  the 
uterus,  with  its  right  Fallopian  tube  (when  the  woman  is 
lying  on  her  back)  lower  in  the  pelvis  than  the  left  tube, 
must  lead  to  a  greater  amount  of  semen  getting  into  the  right 
tube,  and  thus  the  chances  of  male  ova  being  fertilised  are 
much  increased.  Now,  if  the  woman  turn  on  to  her  right 
side  just  after  coition,  the  chances  of  semen  entering  the 
right  tube  and  so  fertilising  a  right  or  male  ovum  are  still 
further  increased,  because  the  uterine  opening  of  the  right 
tube  will  then  be  at  the  lowest  possible  level.  It  is  doubt- 
less due  to  this  anatomical  fact  that  the  idea  has  had  a 
substratum  of  truth  to  keep  it  alive. 

Similarly,  turning  on  to  the  left  side  will  be  quite  as 
effectual,  although  the  uterine  opening  of  the  left  tube  is 
not  (in  the  dorsal  position)  already  on  a  decidedly  lower 
level,  as  is  the  right  tube;  certain  it  is,  however,  that  it 
will  be  at  the  lowest  level  when  the  woman  turns  on  to  her 
left  side. 

Hence  we  see  there  is  an  anatomical  reason  for  crediting 
turning  on  the  side  just  after  coition  with  helping  to  procure 
the  sex  required;  we  must  not  forget,  however,  that  the 
primary  essential  to  successful  fertilisation,  following  turning 
on  one  or  other  side,  is  the  presence  in  the  tube  of  that  side 
of  a  fertilisahle  ovum  from  the  corresponding  ovary. 

We  must  not  overlook  that,  although  position  may  lead 
to  one  or  other  tube  receiving  most  semen,  yet  the  spermato- 
zoa are  able  to,  and  do,  travel  very  greatly  in  virtue  of  their 
own  motility,  as  is  proved  in  cases  of  pregnancy  without 
actual  penetration  or  vaginal  insemination. 

This  fact  of  lateral  inclination  leading  the  semen  to  the 
tube  whose  uterine  opening  is  thus  on  the  lower  level  is 
made  use  of  by  stock-breeders,  who,  by  placing  a  cow  or 


Ii8  THE  CAUSATION  OF  SEX 

mare  looking  down,  and  standing  with  one  side  down  a 
slope,  endeavour  thus  to  direct  the  spermatozoa  into  the 
**  side  "  of  the  uterus  which  is  down-hill,  and  so  give  them 
the  sexed  foetus  they  require. 

I  have  seen  this  followed  by  the  desired  result,  though  it 
is  of  course  evident  that  it  may  fail  because  the  ovary  of  the 
side  which  gives  the  sex  desired  has  not  ovulated ;  for  every- 
thing points  to  the  fact  that  in  the  monotocous  animal 
ovulation  takes  place  unilaterally,  and  from  each  ovary 
alternately. 

A  Scotch  stock-breeder  puts  the  whole  matter  to  me  thus ; 

'*  It  is  a  well-known  fact  that  the  mother  carries  a  colt  foal  or  a 
bull  calf  on  the  right  side,  and  a  filly  or  heifer  on  the  left ;  so  that 
if  a  mare  is  covered  and  left  standing  with  her  right  side  down  hill, 
she  will  have  a  colt  (or  male)  foal." 

He  has  been  successful  in  this  wa3^  and  tells  me  a  veteri- 
nary surgeon  at  the  West  of  Scotland  Agricultural  College 
has  claimed  successful  production  of  the  desired  sex  in  one 
hundred  consecutive  cases. 

This,  therefore,  is  a  practical  demonstration  that  the 
right  ova  are  male,  and  by  directing  the  spermatozoa  to 
the  right  Fallopian  tube  the  production  of  a  male  is  rendered 
more  probable. 

Having  thus  seen  the  effects  of  lateral  decubitus  on  the 
determination  of  sex,  I  shall  now  consider  the  effects  of 
sex  on  lateral  decubitus  in  the  pregnant  woman. 

I  have  already  shown  that  occasionally  the  placenta  is 
fixed  quite  to  one  or  other  lateral  wall  of  the  uterus,  but 
more  usually  it  is  situated  on  the  anterior  or  posterior  wall, 
slightly  more  to  that  side  of  the  mid-line  which  corresponds 
to  the  ovary  which  produced  the  ovum.     Borland^  says: 

"  The  point  of  attachment  of  the  fecundated  ovum  is  generally 
high  up  on  the  posterior  uterine  wall,  near  the  orifice  of  one  of  the 
Fallopian  tubes." 

From  manual  examination  of  the  interior  of  the  uterus 
just  after  the  birth  of  the  child,  Dr.   Tuckey'^  was  able 

1  Borland,  "  Modern  Obstetrics,"  2nd  ed.  1901,  p.  46. 

2  "  Medical  Press  and  Circular." 


LATERAL  DECUBITUS  AND  SEX  CAUSATION     119 

on  several  occasions  to  find  the  placenta  attached  chiefly 
to  the  left  side  of  the  uterine  mid-line  when  the  child  was 
a  female,  and  to  the  right  side  of  the  mid-line  of  the  cavity 
when  the  child  was  a  boy;  from  this  he  too  came  to  the 
conclusion  that  boys  were  derived  from  the  right  ovary 
and  girls  from  the  left,  but  he  did  not  dissociate  the  father 
from  any  share  in  sex  causation. 

It  is  evident,  from  this  lateral  position  of  the  placental 
site,  that  the  child  usually  develops  more  to  one  side  of  the 
uterus  than  the  other;  and  from  this  R.  von  Braun^  has 
derived  the  earliest  evidence  of  pregnancy — a  furrow  form- 
ing and  dividing  the  uterus  into  two  different-shaped  lateral 
halves,  the  pregnant  and  the  non-pregnant. 

"  Its  presence  he  attributes  to  changes  in  consistence  and  the 
alteration  between  contraction  and  relaxation  of  the  portion  of  the 
organ  in  which  the  ovum  is  situated." 

The  pregnant  side  of  the  uterus  being  thicker  in  an  antero- 
posterior direction. 

It  is  thus  somewhat  akin  to  the  pregnant  and  non-pregnant 
cornu  of  a  bifid  uterus. 

The  male  ovum  having  entered  the  right  lateral  half  of 
the  uterus  chiefly  develops  on  that  side,  while  the  female 
similarly  develops  more  on  the  left  of  the  uterus;  hence  it 
comes  to  pass  that  the  sex  of  the  child  a  woman  is  carrying, 
in  some  cases  influences  the  posture  in  which  she  sleeps, 
for  if  a  woman  being  pregnant  with  a  girl  lies  on  her  left 
side  she  has  no  pain  because  the  relations  of  the  foetus  and 
the  placenta  are  not  disturbed ;  if  she  turn  over  on  the  other 
side,  however,  the  child  falls  downwards  to  the  lower  level 
of  the  right  side  and  thus  leads  to  dragging  on  the  placenta 
situated  to  the  left  side,  and  the  pain  soon  makes  her  turn 
again  to  the  painless  side.  It  is  to  be  remembered  that  by 
the  time  the  placenta  is  formed,  the  child  floats  in  the 
liquor  Amnii  and  is  capable  of  considerable  movement  in 
utero. 

Similarly,  if  pregnant  with  a  boy,  turning  on  her  left  side 
gives  pain  because  the  child,  falling  downwards  towards  the 
lower  left  side,  drags  by  its  umbilical  cord  upon  its  placental 

1  Quoted  by  W.  Williams,  op.  ciL,  p.  162. 


120  THE  CAUSATION  OF  SEX 

site  on  the  right  side  of  the  uterus ;  if  however  she  He  on  her 
right  side,  the  side  corresponding  to  the  sex  of  the  child,  no 
pain  is  complained  of,  for  the  child  and  the  placenta  are 
approximated. 

The  following  cases  will  support  this: — 
Mrs.  H.  R.  B.,  when  pregnant  with  her  girl,  noticed  she 
could  only  sleep  on  her  left  side — i.e.  she  could  lie  on  her 
right  side  for  a  short  time,  but  could  not  get  off  to  sleep  if 
lying  on  the  right  side. 

Now  (April  igo2)  she  is  again  pregnant,  she  can  only  sleep 
on  her  right  side,  and  she  finds  her  position  for  comfortably 
sleeping  is  exactly  opposite  to  what  it  was  during  her  last 
pregnancy. 

From  this  one  fact  alone  I  foretold  she  would  have  a  boy. 
A  boy  was  safely  born  in  June  1902. 

Mrs.  O.  S.  had  7  boys  and  i  girl.  She  noticed  that 
movement  in  bed  gave  her  far  more  pain  on  the  left  side, 
when  carrying  the  girl,  than  on  her  right  side.  She  could 
not  lie  on  the  right  side  when  pregnant  with  the  girl — in 
fact,  she  said  "  She  could  not  sleep  at  all  on  the  right  side 
when  carrying  the  girl."  She  found  lying  on  the  left  side 
eased  the  left-sided  pain.  She  always  slept  and  lay  on  her 
right  side  when  pregnant  with  the  males,  and  noticing  the 
difference  in  the  decubitus  made  her  think  she  was  not 
going  to  have  a  boy,  when,  unknown  to  her,  she  was  pregnant 
with  a  girl. 

Mrs.  D.  B.  had  5  girls  followed  by  3  boys.  She  could 
only  lie  on  her  left  side  (for  any  length  of  time)  when  she 
was  pregnant  with  a  girl.  During  her  last  three  pregnancies 
she  found  it  was  uncomfortable  to  lie  on  her  left  side — in 
fact  she  could  not  do  so  for  long. 

After  the  first  boy  was  born,  when  she  was  again  pregnant, 
she  felt  sure,  and  correctly  foretold  on  two  occasions,  that 
she  was  again  to  have  a  boy,  owing  to  her  inability  to  lie 
on  her  left  side  in  those  last  two  pregnancies. 

She  could  only  lie  on  her  right  side  for  long  when  she 
■'  carried  "  the  boys. 

The  next  case  is  not  quite  so  conclusive. 
Mrs.  C.  S.  had  4  girls  followed  by  2  boys.     When  pregnant 
with  the  two  boys  she  could  only  sleep  on  her  right  side. 


LATERAL  DECUBITUS  AND  SEX  CAUSATION     121 

When  pregnant  with  the  girls  she  could  sleep  in  any 
position. 

We  thus  see  that  the  sex  of  the  child  has,  in  some  few 
cases  at  least,  a  determining  influence  on  the  position  in 
which  the  pregnant  woman  can  most  comfortably  lie. 

Of  course  if  the  placenta  be  attached  to  the  mid-line  of 
either  the  anterior  or  posterior  wall  of  the  uterus  the  patient 
does  not  experience  these  definite  unilateral  pains  when 
lying  down. 


CHAPTER  XVII 

THE   PROPORTION    OF    THE    SEXES    IN 
INDIVIDUAL    HUMAN    FAMILIES 

There  is  no  fixed  or  stereotyped  composition  in  the  human 
family,  and  the  proportion  of  the  sexes  to  be  born  to  any 
one  couple  is  an  uncertainty,  while  the  different  families 
which  different  parents  have,  or  rather  used  to  have,  present 
an  infinite  variety. 

This  uncertainty  has  given  rise  to  endless  heartburnings 
and  suspense. 

The  statistics  of  present-day  families,  however,  are  quite 
useless  for  the  study  of  the  proportion  of  different-sexed 
children  born  to  each  married  couple;  hence  we  have  to 
look  backwards  to  the  days  of  our  grandparents,  to  the 
olden  days  of  earlier  marriages,  and  prior  to  what  may  be 
called  "  the  artificial  prevention  of  pregnancy  era."  Then 
the  marriage  of  two  healthy  individuals  naturally  led  to 
large  families,  with  the  children  of  different  sexes ;  and  many 
and  diverse  were  the  designs  in  pins,  etc.,  expressive  of 
welcome  to  the  "  little  stranger."  These  are  now  irarely 
seen,  though  suspense  as  to  the  sex  of  the  coming  infant 
still  precedes  its  birth. 

The  following  may  be  looked  upon  as  cases  of  natural 
families ;  they  are  examples  of  well-assorted  ovarian  activity. 

Mrs.  R.  had  her  children  thus:  i,  B^;  2,  3,  4,  5,  g^; 
6,  b;  7,  8,  twin  g;  9,  10,  11,  12,  13,  14,  15,  b;  16,  17, 
B  and  G  twins. 

Mrs.  K.  had  i,  2,  3,  4,  5,  b;  6,  7,  g;  8,  b;  9,  g;  10,  b;  ii, 
12,  twin  b;  13,  14,  b. 

1  B  =  boy,  G  =  girl.  The  iigures  denote  the  order  of  birth,  and  show 
the  number  in  the  family. 

122 


PROPORTION  OF  THE  SEXES  IN  FAMILIES     123 

Mrs.  W. :  i,  b;  2,  g;  3,  b;  4,  5,  g;  6,  7,  8,  b;  9,  10,  g;  ii, 
b;  12,  13,  G. 

Mrs.  P.  B.:  i,  g;  2,  b;  3,  g;  4,  b;  5,  g;  6,  7,  8,  9,  10,  11, 
b;  12,  g;  13,  14,  b;  15,  g. 

Mrs.  B.  R. :  i,  g;  2,  b;  3,  4,  g;  5,  6,  b;  7,  8,  g;  9,  b;  10, 
II,  12,  g;  13,  B. 

Mrs.  L.  v.:  i,  2,  twin  b;  3,  b;  4,  g;  5,  b;  6,  7,  8,  g;  9, 

10,  II,  b;  12,  13,  g;  14,  B. 

Mrs.  G.:  i,  2,  3,  b;  4,  g;  5,  6,  b;  7,  8,  9,  10,  11,  g;  12, 

13.  i4»  B. 
Mrs.  G.  L.  P.:  i,  2,  3,  4,  g;  5,  6,  b;  7,  8,  g;  9,  b;  10,  g; 

11,  b;  12,  G. 

Mrs.  O. :  I,  G ;  2,  3,  B ;  4,  G ;  5,  6,  7,  B ;  8,  9,  (i ;  10,  b. 

In  the  following  cases  of  families  with  numerous  children, 
the  different  sexes  came  quite  alternately: 

Mrs.  S.  B.  T. :  i,  3,  5,  7,  9,  11,  13,  15,  girls; 
2,  4,  6,  8,  10,  12,  14,  16,  boys. 
Mrs.  W. :  i,  3,  5,  7,  girls;  2,  4,  6,  8,  boys. 
Mrs.  R. :  i,  3,  5,  7,  9,  boys;  2,  4,  6,  8,  10,  girls. 
Mrs.  A.  P.  S. :  i,  3,  5,  7,  9,  girls;  2,  4,  6,  8,  boys. 
Mrs.  T.  S. :  i,  3,  5,  7,  9,  boys;  2,  4,  6,  8,  girls. 
Mrs.  N. :  i,  3,  5,  7,  9,  11  and  12,  boys;  2,  4,  6,  8,  10,  girls. 
Mrs.  L. :  i,  3,  6,  7,  9  and  10,  boys;  2,  4,  5,  8,  11,  girls. 
Mrs.  H.  C. :  i,  3,  5,  7,  boys;  2,  4,  6,  girls. 
Mrs.  C.  B. :  i,  3,  5,  7,  8  and  g  (twin),  girls;  2,  4,  6,  boys. 
Mrs.  D. :  i,  4,  6,  8,  10,  boys;  2,  3,  5,  7,  9,  11,  girls. 

These  cases  of  women  giving  birth  to  children  of  different 
sex  alternately  give  some  support  to  the  contention  of  the 
alternate  action  of  the  ovaries;  certainly  they  are  proof  of 
the  activity  of  both  ovaries.  They  manifestly  quite  dis- 
prove such  theories  of  sex  as  the  relative  age  of  parents,  or 
relative  vigour  of  the  parents.  For  we  can  hardly  expect 
relative  vigour  to  alternate,  say,  every  second  year; 
while  for  the  relative  age  to  alternately  vary  is  of  course 
impossible. 

That  in  the  healthy  state  both  ovaries  are  active,  and 
that  both  normally  ovulate  regularly,  is  borne  out  by  the 


124  THE  CAUSATION  OF  SEX 

occurrence  in  families  of  an  equal  number  of  children  of 
each  sex,  irrespective  of  the  order  of  their  birth.  Thus, 
from  many  of  my  patients  and  friends  the  following  cases 
will  support  this  statement: 

Mrs.  K.  H.  B.  had  8  boys  and  8  girls. 
Mrs.  B.  G.  „    8      „      „    8    „ 

Mrs.  P.  „    7      „      „    7    „ 

Mrs.  L.  K.  „    7      »      ,,    7    ,> 

Mrs.  B.  D.  R.     „    6      „      „    6    „ 

Mrs.  F.  K.,  Mrs.  G.  S.,  Mrs.  C,  Mrs.  P.  G.  G.,  Mrs.  C.  G., 
Mrs.  A.,  Mrs.  R.,  Mrs.  K.  V.,  and  Mrs.  M.  all  had  ten  children, 
five  of  each  sex. 

These  cases  go  to  prove  that  the  two  ovaries  settle  the 
sex,  and  that  each  sex  is  equally  likely  to  occur  with  the 
slight  preponderance  of  males  (io6  to  loo)  due  to  the 
slightly  larger  right  ovary. 

These  cases  also  should  disprove  such  theories  of  sex 
causation  as  relative  age  and  vigour  of  parents,  as  neither 
age  nor  vigour  can  be  supposed  to  change  about  so 
as  to  allow  an  equal  number  of  children  of  both  sexes  to 
be  born. 

I  have  the  names  and  particulars  of  many  other  families 
of  eight  children,  four  of  each  sex,  and  of  six  and  four  show- 
ing sexes  equally  divided ;  but  I  have  only  included  the  more 
numerous  families,  to  show  it  was  no  coincidence. 

If,  instead  of  both  ovaries  being  active,  only  one  ovary 
is  active,  the  other  being  functionless  or  absent — that  is, 
Unilateral  Sterility — we  get  all  the  children  borne  by  that 
woman  of  the  same  sex,  because  ova  of  only  one  side,  and 
therefore  one  sex,  are  provided. 

Unilateral  Sterility. — There  are  several  reasons  to 
account  for  the  inactivity  of  one  ovary,  or  Unilateral 
Sterility,  as  I  have  elsewhere  called  it. 

The  CHIEF  CAUSE  of  this  sterihty  of  an  ovary  is  an  in- 
flammatory one.  Very  frequently  after  a  confinement  some 
inflammatory  mischief  sets  in  round  about  the  uterus,  or 
round  one  or  other  Fallopian  tube  or  ovary,  and  leads 
either  to  the  tube  being  obliterated  or  bound  down,  or  the 


PROPORTION  OF  THE  SEXES  IN  FAMILIES     125 

ovary  being  thus  affected.     This  may  occur  after  the  first 
or  any  subsequent  confinement. 

Indeed,  Drs.  Hart  and  Barbour  ^  say : 

"  It  is  the  rare  exception  to  examine  a  parous  female  pelvis  with- 
out finding  some  traces  of  a  previous  cellulitis  or  peritonitis  "; 

and  on  p.  155  (prognosis  as  to  sterility  after  pelvic  peri- 
tonitis) : 

"  The  mechanical  closure  by  pressure  of  the  Fallopian  tube,  and 
ovaritis,  rendering  ovulation  impossible,  are  conditions  often  pro- 
duced." 

Another  cause  would  be  cases  of  severe  appendicitis 

RIGHT  TUBE 


Fig.  19. — Diagram  of  Right  Salpingitis.     (Modified  from  Martin.) 

The  right  tube  is  both  thickened  and  closed  from  inflammation  and  adherent  to  the  right  ovary, 
leading  to  right-sided  sterility,  so  that  future  children  would  be  females. 

leading  to  inflammatory  binding  down  of  the  right  tube  and 
ovary  (cf.  Dr.  T.  G.'s  case,  p.  175). 

Another  cause  of  Unilateral  Sterility  is  a  rudimentary 
or  undeveloped  condition  of  one  ovary,  as  in  the  following 
case: 

A.  W.,  aged  32,  died  in  Westminster  Hospital  of  cancer  of 
the  breast.  P.M.  "  The  uterus  was  large  and  subinvoluted, 
the  right  ovary  was  rudimentary."  It  was  a  case  of  un- 
developed ovary. 

Such  cases  lead  to  all  children  being  of  the  same  sex. 

Other  causes  of  unilateral  inactivity  of  an  ovary  are 
shrivelling,  atrophy,  or  cirrhosis  of  the  ovary,  the  proper 
ovulating  tissue  of  the  ovary  being  destroyed. 

1  Hart  and  Barbour,  op.  cit.,  p.  159. 


126  THE  CAUSATION  OF  SEX 

H.  Reeves,^  F.R.C.S.  Ed.,  described  a  case  of  cirrhotic 
right  ovary  in  a  woman  the  subject  of  left  ovarian  pregnancy. 
The  foetus  developed  in  and  from  the  left  ovary,  and  was 
a  girl. 

Another  cause  of  Unilateral  Sterility  is  advanced  dis- 
ease in  one  ovary  sufficient  to  prevent  ovulation. 

Dr.  Spencer  ^  described  a  case  of  large  dermoid  tumour  of 
the  right  ovary:  the  woman  became  pregnant  and  gave 
birth  to  a  girl,  because,  owing  to  the  diseased  condition  of 
the  right  ovary,  the  left  ovary  must  have  provided  the 
ovum. 

Dr.  Galahin^  showed  tumours  of  both  ovaries  removed 
at  the  fourth  month  of  pregnancy: 

"  The  right  tumour  was  a  dermoid  cyst  containing  gruel-Uke  fluid, 
which  soHdified  on  cooling.  It  contained  also  hair,  loose  teeth, 
and  bone." 

"  The  left  tumour  was  an  ordinary  cystic  adenoma,  except  that 
three  small  cysts  in  it  were  evidently  dermoid.  In  the  left  tumour 
was  seen  a  large  corpus  luteunt  of  pregnancy,  and  near  it  a  small 
jragmerA  oj  unaltered  ovary  " — definite  proof  that  this  left  ovary 
supplied  the  oosperm. 

Unfortunately  the  sex  of  the  child  when  ultimately  bom 
was  not  given ;  but  I  feel  confident  it  was  a  girl. 

Milander  described  a  case  where  the  left  ovary  was  calci- 
fied and  detached,  and  was  lying  free  in  the  pelvis.  It  is 
evident  that  that  ovary  could  not  ovulate. 

Congenital  absence  of  one  ovary  must,  of  course, 
result  in  Unilateral  Sterility,  or  the  production  of  one  sexed 
children  only.  Such  cases  are  rare,  but  of  course  give 
absolute  proof  that  one  ovary  produces  only  one  sex. 

A  very  remarkable  case  is  described  by  Sir  J.  Bland- 
Sutton."^  A  woman,  aged  33,  had  given  birth  to  a  boy, 
when,  because  of  a  painful  swelling  behind  the  uterus, 
abdominal  section  was  performed: 

"  The  uterus  was  found  to  be  of  the  imicorn  variety,  and  to  possess 
one  Fallopian  tube  and  a  well-developed  ovary  on  the  right  side.     The 

1  H.  Reeves,  "  Lancet,"  Oct.  1890,  p.  872. 

2  H.  R.  Spencer,  •"  Trans.  Obstet.  Soc.,"  1898,  pp.  16-18. 
'^  Galabin,  "  Trans.  Obstet.  Soc,"  1896,  p.  loi. 

4  Bland-Sutton,  "  Surgery  of  Pregnancy  and  Labour  complicated  with 
Tumours."     "  Lancet  "  Reprint,  vol.  i.  p.  50,  1901. 


PROPORTION  OF  THE  SEXES  IN  FAMILIES     127 

left  side  of  the  uteru.s  was  smooth  and  rounded,  and  lacked  a  broad 
ligament,  ovary,  and  Fallopian  tube. 

"  The  right  kidney  occupied  its  proper  position;  the  left  one  lay- 
in  the  hollow  of  the  sacrum,  and  proved  to  be  the  body  behind  the 
uterus.  The  patient  made  an  uninterrupted  recovery.  About 
fourteen  months  afterwards  the  patient  conceived,  and  had  the 
satisfaction  of  being  delivered  of  a  fine  child,  a  boy." 

No  case  could  be  more  conclusive.-^  The  patient  had 
given  birth  to  a  son  before  an  operation  disclosed  the  fact 
that  her  left  kidney  was  congenitally  misplaced — further, 
that  not  only  was  the  uterus  undeveloped  and  defective 
on  the  left  side,  but  that  her  left  Fallopian  tube  and  left 
ovary  were  entirely  absent.  After  the  operation  she  became 
pregnant,  and  gave. birth  to  another  boy. 

Thus  there  were  two  sons  born  to  a  woman  who  possessed 
only  the  right  ovary  in  her  body. 

This  unilateral  steriHty  is  of  course  also  caused  by  uni- 
lateral ovariotomy,  or  the  complete  removal  of  an  ovary 
and  tube  from  one  side  by  operation.  The  post-operative 
children  in  these  cases  (compare  Chapter  X.)  are  all  of  the 
same  sex,  because  one  ovary  only  breeds  one  sex. 


Children  all  the  same  sex. 

I  have  in  Chapter  VII.  alluded  to  the  fact  that  many 
females  have  all  the  same  sex  offspring  even  with  different 
husbands,  or  in  the  case  of  animals  with  multiple  male 
animals,  showing  that  the  question  of  sex  rests  only  with 
the  mother ;  but  in  the  ordinary  married  state  of  one  husband 
to  one  wife  it  is  very  remarkable,  to  say  the  least,  how  often 
that  couple  will  only  give  birth  to  children  of  one  sex.  It 
points  to  the  fact  that  only  one  ovary  is  active. 

The  following  are  cases  in  point,  selected  from  families 
where  the  mother  has  finished  childbearing.  Only  those 
having  six  or  more  children  are  given,  less  than  that  number 
hardly  being  conclusive: 

^  A  reviewer  objects  to  this  case  being  called  a  conclusive  proof  in 
favour  of  my  theory.  I-Iad  he  found  a  case,  recorded  by  as  reliable  an 
authority  as  Sir  J.  Bland-Sutton,  of  absent  left  ovary,  with  the  birth  of 
two  girls  from  ova  from  the  right  ovary,  he  would,  no  doubt,  have  written 
of  it  as  a  conclusive  proof  of  the  fallacy  of  ray  theory. 


128 


THE  CAUSATION  OF  SEX 


Mrs.  G.  M.      had 

1 8  boys 

Mrs.  W.        had  20  girls 

..     E.  R  S.     „ 

15  .,  1 

..    H.  B.      „    14     „    1 

„    S.  B. 

II     ,, 

„    R.  H.      , 

.    13     „ 

..    T.P. 

9     „ 

..    M. 

,    II     ,, 

,.    S.H. 

9     ., 

„    T.  L. 

,    10     „ 

..    B. 

8     „ 

„    D.  M. 

.    10     ,, 

„     K.  W. 

8     „ 

..    B.  L.  G. 

„     9     ., 

,.    H.  S. 

7     » 

„    M.  R. 

.      9     „ 

„    R.  S.  B.     „ 

8     „ 

XT         1      ,.    C.  B. 

,      8     „ 

„    T.  V.  M.    „ 

8     „ 

^^g^^^^    ;;    G.D. 

,      8     „ 

„   c.  S. 

7     .. 

„    S.H. 

,.     8     „ 

..    D.C. 

7     » 

„    L.  C. 

'     7     » 

,.    E.W. 

7     » 

,r       A. 

'     7     » 

„    B.  S. 

7     .. 

„    H.U. 

.,     7     » 

„    W.  N.  S.    „ 

7     .. 

„    F.W. 

„     7     » 

„    L.  S.  H.     „ 

7     .. 

„    W.  H. 

„     6     „ 

„    M. 

6     „ 

..    L.  F. 

„      6     „ 

„  z. 

6     „    j 

„    W.  S. 

„      6      ..  ^ 

No  boys 


I  have  details  of  many  other  famihes  of  smaller  numbers 
not  necessary  to  quote. 

In  cases  of  succession  to  title  or  fortune  the  extreme 
importance  of  having  a  son  and  heir  is  evident ;  some  women, 
however,  are  quite  unable  to  provide  a  male  ovum  for 
fertilisation,  owing  to  Unilateral  Sterility,  however  caused. 

"  A  celebrated  case,^  which  attracted  great  attention,  occurred 
in  the  family  of  Sir  Francis  Willoughby,  who  died  seised  of  a  large 
inheritance.  He  left  -five  daughters  (one  of  whom  was  married  to 
Percival  Willoughby),  but  not  any  son.  His  widow  at  the  time  of 
his  death  stated  that  she  was  with  child  by  him.  This  declaration 
was  evidently  one  of  great  moment  to  the  daughters,  since,  if  a  son 
should  be  born,  all  the  five  sisters  would  thereby  lose  the  inheritance 
which  descended  to  them.  Percival  Willoughby  prayed  for  a  writ 
de  ventre  inspiciendo,  to  have  the  widow  examined,  and  the  Sheriff  of 
London  was  accordingly  directed  to  have  it  done.  He  returned  that 
she  was  twenty  weeks  gone  with  child,  and  that  within  twenty  weeks 
fuit  paritura.  Whereupon  another  writ  issued  out  of  the  Common 
Pleas,  commanding  the  Sheriff  safely  to  keep  her  in  such  an  house, 
and  that  the  door  should  be  well  guarded ;  and  that  every  day  he 
should  cause  her  to  be  viewed  by  some  of  the  women  named  in  the 
writ  (wherein  ten  were  named),  and  when  she  should  be  delivered, 
that  some  of  them  should  be  with  her  to  view  her  birth,  whether  it  be 
male  or  female,  to  the  intent  there  should  not  be  any  falsity.  And 
upon  this  writ  the  Sheriff  returned,  that  accordingly  he  had  caused 
her  to  be  so  kept,  and  that  on  such  a  date  she  was  delivered  of  a 
daughter." 

So  she  had  in  all  six  girls  and  no  boy. 

^  Montgomery,  "  Signs  and  Symptoms  of  Pregnancy,"  1837,  p.  35. 


PROPORTION  OF  THE  SEXES  IN  FAMILIES     129 

I  conclude  these  cases  with  the  following  two  extracts 
from  newspapers,  but  cannot  vouch  for  their  accuracy,  as 
I  can  of  the  above-mentioned  cases : 

"  Daily  Mail,"  April  22,  1901: 

"  The  recent  census  in  Italy  has  revealed  some  extraordinary  cases. 
The  wife  of  a  Turin  labourer,  named  Marie  Danna,  who  married  at 
19,  and  is  now  59,  has  had  thirty-jour  sons.  Thirty-one  are  now 
living,  and  are  all  at  home  with  their  parents." 

"  Daily  Mail,"  March  5,  1897: 

"  An  inhabitant  of  Arendskerke,  in  Holland,  has  notified  to  the 
municipal  registrar  the  birth  of  his  twenty-first  son,  all  the  others 
being  alive  and  in  the  enjoyment  of  good  health." 

The  above,  then,  are  cases  where  the  activity  of  one 
ovary  is  lost,  the  first  fertilised-ovum-supplying  ovary  being 
the  only  one  remaining  active,  and  hence  all  the  children 
are  of  the  same  sex. 

Another  class  of  family  is  where  the  sex  of  the  first 
pregnancy  differs  from  those  that  follow,  thus : 


Mrs.  W.  had  first  a  boy,  then 

Mrs.  W.  J.  had  first  a  girl. 

II  girls. 

then  i:?  boys. 

Mrs.  B.  B.  had  first  a  boy, 

Mrs.  F.  E.  had  first  a  girl, 

then  5  girls. 

then  16  boys. 

Mrs.  S.  M.  H.  had  first  a  boy, 

Mrs.  McC.  had  first  a  giiY, 

then  5  girls. 

then  6  boys. 

Mrs.  H.  M.  had  first  a  boy, 

Mrs.  B.  P.  had  first  a  girl, 

then  6  girls. 

then  9  boys. 

Mrs.  V.  B.  had  first  a  boy. 

Mrs.  P.  L.  had  first  a  girl, 

then  10  girls. 

then  10  boys. 

Mrs.  N.  had  first  a  boy,  then 

Mrs.  L.  S.  had  first  a  girl, 

8  girls. 

then  7  boys. 

Mrs.  Y.  had  first  a  boy,  then 

Mrs.  W.  M.  had  first  a  girl. 

7  girls. 

then  6  boys. 

Mrs.  H.  had  first  a  boy,  then 

Mrs.   C.   H.   B.   had  first  a 

6  girls. 

girl,  then  11  boys. 

Mrs.  M.  B.  had  first  a  boy. 

Mrs.  R.  E.  B.  had  first  a  girl, 

then  6  girls. 

then  6  boys. 

Mrs.  D.  had  first  a  boy,  then 

8  girls. 

130 


THE  CAUSATION  OF  SEX 


Here  the  ovary  which  suppHed  the  ovum  for  the  first 
pregnancy  became  after  that  pregnancy  functionally  useless, 
either  from  adhesions,  or  disease  in  it  or  its  tube ;  so  that  in 
all  the  subsequent  pregnancies  the  ova  came  from  the  other 
uninjured  ovary,  and  the  children  were  all  of  the  same  sex, 
and  different  from  the  first  or  primary  pregnancy. 

Here  unilateral  sterility  after  the  first  pregnancy  is  the 
cause. 


A  further  class  of  family  consists  of  cases,  like  that  of 
the  German  Empress,  where  several  boys  are  followed  by 
a  girl;  and  likewise  a  number  of  girls  followed  by  a  boy, 
such  as — 


Mrs.  P.  B.  had  ii  children, 

10  boys  followed    by  i 

girl. 
Mrs.   G.  P.  had  8  children, 

7   boys    followed    by    i 

girl. 
Mrs.    S.    had  8   children,   7 

boys  followed  by  i  girl. 
Mrs.    C.    had  7   children,   6 

boys  followed  by  i  girl. 
Mrs.  C.  A.  had  6  children,  5 

boys  followed  by  i  girl. 


Mrs.  R.  J.  had  9  children,  8 

girls  followed  by  i  boy. 
Mrs.   H.   had  8  children,  7 

girls  followed  by  i  boy. 
Mrs.  R.  had  12  children,  11 

girls  followed  by  i  boy. 
Mrs.  B.  G.  had  9  children,  8 

girls  followed  by  i  boy. 
Mrs.  B.  W.  had  7  children,  6 

girls  followed  by  i  boy. 
Mrs.  L.  N.  had  8  children,  7 

girls  followed  by  i  boy. 


Or  again  these — 

Mrs.  H.  G.  P.  and  also  Mrs.  J.  both  had  5  children,  and 
both  had  2  boys,  then  twin  boys,  and  lastly  a  girl. 

Mrs.  H.  had  8  children,  5  boys,  then  twin  boys,  and  lastly 
a  girl. 

Mrs.  G.  had  12  children,  9  girls,  then  twin  girls,  and  lastly 
a  boy. 

Mrs.  B.  C.  S.  had  22  children,  18  girls,  then  twin  girls, 
followed  by  a  boy,  and  lastly  another  girl. 

In  these  cases  the  binding  down  of  the  ovary  and  tube 
which  did  not  act  must  have  been  undone  either  by  the 
number  of  pregnancies,  or  by  the  lastone,  so  that  the  ovary 
and  tube  were  set  free,  as  it  were,  once-Ti^re,  and  at  last  ware 


PROPORTION  OF  THE  SEXES  IN  FAMILIES     131 

able  to  act,  with  a  change  of  sex  as  a  result.  That  this  libera- 
tion from  adhesions  is  possible  is  stated  by  Hart  and  Barbour^: 

"  The  adhesions  (of  Fallopian  tubes)  may  ultimately  yield  to  the 
stretching  brought  to  bear  on  them  by  the  developing  uterus." 

That  this  does  definitely  occur  is  absolutely  proved  by 
cases  reported  by  Dr.  Herman,^  where  he  says : 

"The  ovary  and  tube,  which  were  in  1886  so  embedded  in  ad- 
hesions that  the  operator  could  not  identify  them,  were  in  1901 
almost  free,  and  were  easily  pulled  up." 

And  by  the  writer,^  in  the  same  journal,  "  the  right  append- 
ages were  so  matted  and  bound  down,"  they  could  not  be 
inspected  in  July  1901 ;  while  less  than  two  years  afterwards 
no  adhesions  were  met  with,  they  had  been  absorbed,  and 
thus  liberated  the  ovary  and  tube. 

This  undoing  or  absorption  of  adhesions  is  now  copied 
by  surgeons  who  artificially  release  bound-down  tubes,  so 
that  "  many  pregnancies  have  occurred  after  simple  freeing 
of  tubes  from  adhesion."     {Mrs.  S.  Boyd.) 

Frequent  repetition  of  pregnancy — that  is,  a  woman 
having  several  children  rapidly ;  as  well  as  cases  of  hydram- 
nios  (dropsy  of  the  womb) ;  and  also  cases  of  twins,  which 
lead  to  excessive  distension  of  the  uterus  during  pregnancy ; 
would  all,  owing  to  the  stretching  caused  by  them,  be  most 
likely  to  lead  to  absorption  of  adhesions  round  an  ovary 
or  tube. 

Note,  therefore,  the  above  cases  of  twins  being  followed 
by  a  change  in  the  sex  of  the  succeeding  child. 

In  some  cases  the  presence  of  children  all  of  the  same 
sex  is  doubtless  due  to  mere  chance,  fertilisation  happening 
always  to  occur  to  the  ova  from  one  and  the  same  ovary; 
i.e.  fortuitous  fertilisation.  Conception  occurs  to  an  ovum 
from  the  same  ovary  that  supplied  the  ovum  for  the  last 
child  born,  hence  the  same  sex  child  is  again  born ;  whereas, 
had  conception  occurred  a  month  earlier  or  later,  a  different 
sex  child  would  have  appeared. 

1  Hart  and  Barbour,  op.  cit.,  p.  155. 

2  Herman,  "  Journal  of  Obstetrics  and  Gynaecology  of  the  British 
Empire,"  vol.  ii.  1902,  pp.  226-228. 

3  E.  Rumley  Dawson,  "  Journal  of  Obstetrics  and  Gynaecology,"  vol. 
iv.,  Sept.  1903,  pp.  301-3. 


CHAPTER  XVIII 

MULTIPLE  CONCEPTIONS  OR  MULTIPLE 
PREGNANCY 

Having  explained  the  production  of  single  births  by  means 
of  my  theory,  it  remains  to  see  whether  the  theory  will 
equally  well  explain  the  production  of  plural  conceptions, 
twins  and  triplets,  etc. 

In  looking  for  an  explanation  of  the  occasional  birth  of 
more  than  one  child,  we  must  not  forget  that,  to  quote 
Play f air ^  "  Plural  births  must  not  be  classified  as  natural 
forms  of  pregnancy,"  or,  as  Garrigiies^  says,  "Multiple 
foetation  must  be  looked  upon  as  an  abnormal  event." 

Twins. 

As  regards  the  origin  of  twins,  there  are  four  ways  in 
which  they  arise. 

Variety  A.    2  G.  Fs./  2  ovaries,  2  ova,  2  sexes. 

In  these  cases  each  ovary  matures  a  G.  F.  at  or  about  the 
same  time,  so  that  we  get  one  G.  F.  with  an  ovum  each  from 
each  ovary,  therefore  the  foetuses  are  of  opposite  sexes,  one 
male,  one  female. 

Play  fair  says : 

"  In  the  largest  number  of  cases  of  twins  the  children  are  of 
opposite  sexes." 

Spiegelberg,  Pinard,  Simpson,  and  Berry  Hart,  all  confirm 
this. 

Veit,"^  quoted  by  Lusk,  found  in  150,000  cases  of  twins, 

1  Playfair,  op.  cit.,  vol.  i.,  1898. 

2  Garrigues,  "  Text-book  of  Obstetrics,"  1902,  p.  258. 

3  G.  F.=Graafian  follicle. 

*  Lusk's  "  Text-book  oi  JVIidwifery, "  1889,  p.  230. 

132 


MULTIPLE  PREGNANCY  133 

in  54,000  the  children  were  boy  and  girl,  in  50,000  they  were 
both  boys,  and  in  46,000  they  were  both  girls. 

Churchill,^  out  of  1,321  cases  of  twins,  found  there  were 
495  cases  of  boy  and  girl,  416  cases  of  two  boys,  while  409 
were  cases  of  two  girls. 

Rumpe,  quoted  by  Jewett,  "  Practice  of  Obstetrics,"  1899, 
p.  296,  found  in  loi  cases  of  two-egg  or  binovular  twins, 
54  were  boy  and  girl — more  than  half,  31  both  boys,  and 
16  both  girls. 

This  marked  preponderance  of  cases  of  boy  and  girl  twins 
over  twin  boys,  or  twin  girls,  must  have  its  definite  cause, 
and  they  are  necessarily  of  opposite  sexes  because  the  two 
ova  come  from  opposite  ovaries.  And  these  cases  of 
different  sexed  twins  are  necessarily  most  numerous,  because 

the  TWO  OVARIES  TOGETHER  ARE  MANIFESTLY  LARGER  THAN 
EITHER  OVARY  ALONE,  SO  THAT  THE  TENDENCY  FOR  THE 
TWO  OVARIES  TO  PRODUCE  TWO  OVA — i.e.  ONE  EACH — AT, 
OR  ABOUT,  THE  SAME  TIME,  MUST  BE  FAR  GREATER  THAN 
FOR  EITHER  OVARY  BY  ITSELF  TO  PRODUCE  TWO  OVA  AT  ONCE. 

Hence  we  find  that  an  ovum  from  each  ovary  is  fertilised 
at,  or  about,  the  same  time,  more  often  than  are  two  ova 
from  the  same  ovary;  but  opposite  sexed  twins  are  the 
commonest,  therefore  we  are  justified  in  saying  that  opposite 
sexed  twins  are  due  to  the  opposite  ovaries  ovulating  almost 
simultaneously. 

There  would  be  a  corpus  luteum  in  each  ovary.  It  is  in 
this  variety  of  twins  that  we  most  often  find  two  separate 
and  distinct  placentae ;  they  may,  however,  be  fused  together. 

This  is  the  only  mode  of  origin  of  different  sexed  twins. 

Variety  B.    2  G.  Fs.  from  1  ovary,  2  ova,  1  sex. 

Here  the  children  are  of  similar  sex,  either  two  boys  or 
two  girls. 

They  are  derived  from  two  G.  Fs.  from  one  or  other 
ovary;  each  G.  F.  contains  a  single  ovum.  In  these  cases, 
which  are  not  so  common,  we  find  (instead  of  each  ovary 
supplying  an  ovum)  one  ovary  alone  will  supply  two  Graafian 
follicles,  so  that  two  ova  are  derived  from  the  same  ovary, 

^  Churchill,  "  Midwifery,"  1866,  5th  ed.  p.  482. 


134  THE  CAUSATION  OF  SEX 

and  therefore  the  twins  are  the  same  in  sex,  either  two  males 
or  two  females,  according  to  which  ovary  the  ova  came  from. 
Play  fair  {op.  cit.,  p.  184)  says: 

"  The  most  common  cause  of  multiple  pregnancy  is  probably  the 
nearly  simultaneous  maturation  and  rupture  of  two  G.  Fs.,  the 
ovules  being  impregiTated  at  or  about  the  same  time." 

This  therefore  applies  to  both  the  varieties  A  and  B. 

The  birth  of  both  a  dark  and  a  light  child  to  a  negress 
is  possible  only  in  one  or  other  of  the  above  two  varieties. 

Birnhanm  described  a  case  of  twin  pregnancy  where  post 
mortem  the  left  ovary  contained  two  corpora  lutea,  but  no 
sex  was  given. 

In  the  following  conclusive  case  two  corpora  lutea  were  in 
the  right  ovary,  the  right  Fallopian  tube  had  burst  and  a 
foetus  had  escaped;  its  sex  is  not  given,  but  I  have  elsewhere 
shown  that  a  foetus  in  the  right  tube  and  corpus  luteum  in 
the  right  ovary  means  a  male  gestation.  The  uterus  con- 
tained another  foetus,  a  male. 

"  New  Sydenham  Society  Year  Book,"  1862,  p.  339, 
quotes  the  following: 

"  Tuffnell's  case. — Patient  pregnant  between  three  and  four 
months.  Post-mortem. — Three  or  four  quarts  of  fluid  and  clotted 
blood  were  found  in  the  abdomen  with  a  small  foetus  floating  therein. 
There  was  a  rent  in  right  Fallopian  tube,  and  a  cyst  from  where 
the  foetus  had  escaped.  Right  Fallopian  tube  and  ovary  agglutinated. 
Foetus  one  inch  long.  The  uterus  contained  a  healthy  male  foetus 
proportionate  to  the  date  of  conception.  The  cystic  cavity  in  the 
right  Fallopian  tube  contained  a  solid  organised  mass  like  a  miniature 
placenta.     There  were  two  distinct  corpora  lutea  in  the  right  ovary." 

This  case  proves  a  twin  male  pregnancy,  with  both  ova 
coming  from  different  Graafian  follicles,  but  from  the  same 
ovary,  the  right.  Hence  the  same  sex,  and  that  male.  One 
foetus  had  developed  in  the  right  tube,  the  other  in  the 
uterus.  It  was  a  combined  Extra-  and  Intra-uterine  male 
pregnancy. 

In  this  variety  of  twins  the  placentae  may,  or  may  not, 
be  fused  or  grown  together,  and  though  there  are  often  two 
quite  distinct  placentae,  I  have  found  a  smgle  fused  placenta 
(showing  evidence  of  the  amalgamation  of  the  two  original 
placental  areas)  in  a  small  majority  of  my  cases. 


MULTIPLE  PREGNANCY  135 

Variety  C.    1  G.  F.,  1  ovary,  2  ova,  1  sex. 

In  this  variety  the  children  are  of  the  same  sex.  One  or 
other  ovary  supphes  the  single  G.  F.  which  happens  to 
contain  two  ova  (cf.  K,  Fig.  8,  p.  17);  the  sex  will  be 
identical,  but  will  depend  on  which  ovary  supplied  the  G.  F. 
Play f air '^  says: 

"It  may  happen  that  a  single  folhcle  contains  more  than  one 
ovule,  as  has  actually  been  observed  before  its  rupture." 

This  anatomical  fact  has  the  support  of  Lusk^  and  Hirst, ^ 
who  reproduce  a  drawing  of  Waldeyer's  showing  the  two 
distinct  ova  in  a  single  G.  F.  Its  occurrence  is  also  admitted 
by  Pier  sol, "^  Berry  Hart,^  and  Whitridge  Williams. 

In  these  cases  only  one  corpus  luteum  would  be  found  in 
one  or  other  ovary,  although  two  children  were  born.  This 
fact  was  distinctly  pointed  out  by  Montgomery,^  who  says. 

"  A  vesicle  may  contain  two  ovules,  in  which  case  twins  may  be 
accompanied  with  only  one  corpus  luteum." 

The  children  in  this  variety  will  more  closely  resemble 
each  other  than  in  Variety  B. 

Variety  D.    1  G.  F.,  1  ovary,  1  ovum  with  2  nuclei,  1  sex. 

The  children  are  of  the  same  sex;  because  they  have 
arisen  from  a  double  nucleus  or  germ-bearing  ovum  derived 
from  one  or  other  ovary,  they  will  be  very  much  alike. 
This  variety  thus  differs  from  the  former,  as  the  single 
G.  F.  contains  but  a  single  ovum,  but  that  ovum  contains  a 
double  germ  or  germinal  vesicle  (as  is  common  in  fowls' 
eggs)  (cf.  H,  Fig.  8,  p.  18) ;  we  thus  get  the  so-called  unioval, 
homologous,  or  identical  twins,  which  are  stated  to  be  seven 
times  more  rare  than  other  forms,  and  we  find  them  not 
only  always  alike  in  sex  (which  fact  Schroeder  pointed  out  long 
ago),  but  sometimes  joined  together.     Play  fair  (p.  186)  says: 

"  Conjoined  twins  must  of  necessity  arise  from  a  single  ovule 
with  a  double  germ,  and  there  is  no  instance  on  record  in  which  they 
were  of  opposite  sexes." 

^  Playfair,  op.  cit.,  p.  185.  2  Lusk,  op.  cit.,  p.  37-  • 

^  Hirst,  op.  cit.,  p.  54.  *  Piersol,  op.  cit.,  p.  143. 

^  Berry  Hart,  "  Guide  to  INIidwifery,"  p.  247. 
Montgomery,  "  Signs  and  Symptoms  of  Pregnancy,"   ist  ed.,   1837, 
p.  231. 


136  THE  CAUSATION  OF  SEX 

This  should,  I  think,  help  to  prove  my  theory,  by  showing 
that  one  ovary  always  "  breeds  true."  That  is,  ova  from 
one  ovary  only  produce  one  sex.  The  children's  hair  will 
always  be  the  same  colour  when  derived  from  a  single  ovum, 
whether  the  twins  are  conjoined  or  not.  Undoubted 
examples  of  ova  with  double  germs  or  two  nuclei  have  been 
reported,  and  are  now  admitted  to  occur  by  most  authorities. 
Norris  and  Dickinson^  reproduce  a  drawing  of  Von  Herff's 
showing  two  well-marked  nuclei  in  one  ovum,  and  Whitridge 
Williams^  figures  a  good  example,  the  two  germinal  vesicles 
or  nuclei  being  distinctly  separated  in  the  ovum;  while  he 
states  that  "  the  existence  of  such  ova  (containing  two  dis- 
tinct germinal  vesicles)  is  indisputable." 

Dr.  T.  Wilson  ^  says : 

"  There  is  a  much  greater  predisposition  to  the  occurrence  of 
hydramnion  in  cases  of  twins  derived  from  a  single  ovum  than  in 
the  commoner  variety  of  twins  developed  from  separate  ova. 

"The  unioval  variety  of  twins  is  of  interest  for  many  reasons. 
The  foetuses  are  always  of  the  same  sex,  and  are  much  more  alike 
than  are  those  developed  from  different  ova.  They  have  a  single 
placenta,  in  which  an  anastomosis  takes  place  between  their  vessels ; 
acardiac  monsters  are  generally  admitted  to  arise  only  in  this 
variety  of  pregnancy." 

Some  cases  of  twins  from  a  single  ovum — possibly  all 
the  acardiacs — are  believed  to  arise,  not  from  double  nuclei 
in  an  ovum,  but  by  splitting  or  division  into  two  of  a  single 
nucleus,  though  no  one  has  seen  such  an  occurrence;  but 
single  nuclei  have  been  seen  to  contain  two  nucleoli  or  germinal 
spots,  as  in  a  specimen  figured  by  Nagel  in  Play  fair's 
"  Midwifery  ";  so  it  is  possible  that,  division  of  the  nucleus 
being  purely  supposititious,  is  not  necessary,  if  it  occur  at  all. 

It  must  not  be  supposed,  if  two  G.  Fs.  rupture,  and  two 
ova  are  discharged,  that  they  are  sure  both  to  be  fertihsed; 
even  if  both  be  fertihsed,  one  may  easily  die  in  the  uterus. 
Play  fair  ^  says : 

"  This  is  proved  by  the  occurrence  of  cases  in  which  there  are 
two  corpora  lutea  with  only  one  foetus." 

1  Norris  and  Dickinson,  "  American  Text-book  of  Obstetrics,"  1897, 
p.  71. 

2  W.  Williams,  op.  cit.,  p.  327. 

^  "  Trans.  Obstet.  Soc,"  1899,  p.  237. 
*  Playfair,  op.  cit.,  p.  184. 


MULTIPLE  PREGNANCY  137 

This  is  confirmed,  as  pointed  out  by  Montgomery,^  by 
many  authors,  and  by  its  occurrence  in  domestic  animals. 
In  one  case  Montgomery  examined  there  were  "  ten  corpora 
lutea  in  the  ovaries  of  a  sow,  biit  only  nine  foetuses  in  the 
uterus/'  After  a  diligent  search  "  the  remains  of  another 
foetus  which  had  been  blighted "  was  found.  I  have 
practically  proved  the  truth  of  this  with  rabbits. 

The  explanation  of  the  development  of  the  second  corpus 
luteum  in  the  absence  of  the  second  foetus  is  that  the 
presence  of  one  foetus  is  quite  sufficient  to  cause  both  corpora 
lutea  to  develop  into  true  corpora  lutea. 

The  Sex  of  Twins. 

From  the  foregoing  particulars  we  see  that  as  regards 
their  sex  twins  occur  in  the  following  order  of  frequency : 

A.  Boy  and  girl  twins. 

B.  Boy  and  boy  twins, 
c.  Girl  and  girl  twins. 

The  first  variety  are  known  as  pigeon-pair  or  different 
sex  twins,  and  occur  most  often;  b  and  c,  consisting  of 
children  of  different  sex,  are  usually  classed  together  as 
same  sex  twins,  and  if  so  added  together  these  two  varieties 
of  same  sex  twins  outnumber  (as  we  should  expect)  the 
first  variety,  or  twins  of  different  sex. 

Variety  b  are  more  numerous  than  c. 

It  is  necessary  to  point  out  very  clearly  this  misleading 
inclusion  of  children  of  different  sexes  under  the  heading 
of  "  same  sex  twins,"  as  astonishing  errors  and  discrepancies 
appear  in  some  text-books  as  to  the  relative  frequency  of 
the  sexes  in  twin  births. 

We  see,  therefore,  that  different  sex  twins  are  more  often 
born  than  either  2  boys  or  2  girls,  but  add  together  the  twin 
boys  and  the  twin  girls  and  call  them  "  same  sex  "  twins, 
then  this  combination  of  boys  and  girls  together  outnumber 
the  cases  of  boy  and  girl  twins — that  is,  though  different 
sex  twins  are  most  often  born,  yet  same  sex  twins  are  most 
numerous  ! 

^  Montgomery,  op.  cit.,  p.  230.  * 


138  THE  CAUSATION  OF  SEX 

Here  I  may  notice  an  objection  raised  by  a  reviewer, 
who  imagined  that  hoy  and  girl  twins  disproved  my  theory ; 
for,  said  he,  it  showed  that  the  ovaries  did  not  always 
ovulate  alternately,  but  that  both  ovaries  must  in  these 
cases  have  acted  at  one  and  the  same  time.  Quite  so,  I 
have  certainly  not  said  they  always  did  act  alternately, 
but  they  do  usually,  normally;  and  when  they  exceptionally 
ovulate  simultaneously,  we  get  the  unusual  or  exceptional 
condition  of  different  sex  twins — provided  both  ova  be 
fertilised,  which,  of  course,  does  not  always  occur. 

Boy  and  girl  or  different-sex  twins,  then,  are  evidence 
of  simultaneous  ovulation  by  both  ovaries.  See  the  cases 
of  twins  in  detail  described  in  Chapter  XXHL,  pp.  191-194, 
showing  which  ovary  acted  "  out  of  its  turn." 

Triplets. — It  will  be  quite  easy  to  understand  how 
triplets  occur  from  what  has  been  said  about  twins,  and  how 
triplets  follow  the  same  rule  as  to  their  sex.  Usually  one 
ovary  gives  rise  to  twins,  and  the  other  to  a  single  birth. 
In  this  case  two  of  the  children  are  alike  in  sex.  If  the 
children  are  all  of  the  same  sex,  one  or  other  ovary  provided 
them  all,  one  G.  F.  providing  either  two  ova,  or  else  one 
ovum  with  a  double  germ,  and  the  other  G.  F.  supplying  a 
single  ovum;  though  one  ovum  may  rarely  give  rise  to  all 
three  children — uniovular  triplets. 

W.  Williams'^  says: 

"  Occasionally  two,  and  sometimes  three,  distinct  ova  may  be 
found  in  a  single  follicle,  and  it  is  from  such  structures  that  multiple 
pregnancies  not  infrequently  develop  "; 

so  that  one  corpus  luteum  only  may  be  found  in  a  case  of 
triplets  of  the  same  sex.  The  case  described  by  Saniter^ 
would  have  been  such  an  example  had  it  been  possible  to 
have  examined  the  ovaries,  for  the  triplets  were  all  males, 
derived  from  a  single  ovum,  and  there  was  only  one  placenta. 
I  have  not  been  able  to  find  a  report  of  a  case  of  three 
corpora  lutea  of  pregnancy  discovered  in  one  and  the  same 
ovary;  but  probably  the  cases  described  by  Dr.  H.  R. 
Spencer^  and  by  Dr.  G.  Bate  in  the  "  Lancet  "  would  each 

1  Williams,  op.  cit.,  p.  63. 

2  Saniter,  "  Brit.  Med.  Journ.,"  Epitome,  March  30,  1901. 

3  Dr.H.  R.Spencer,  "  Trans.Obstet.Soc,"  vol.xxxv.  1893,  pp.  107-110. 


MULTIPLE  PREGNANCY  139 

have  shown  three  corpora  lutea  in  the  left  ovary,  for  the 
triplets  were  "  all  girls,  and  there  were  three  separate 
placentae  "  in  both  cases. 

G.  W.  Thompson^  records  a  case  of  triplets — a  double 
female  monster  and  a  single  male  child: 

"  The  single  male  child  was  born  first,  was  still-born,  and  had  a 
separate  placenta  and  membranes.  The  sex  was  female  of  the  united 
foetus,  which  had  two  heads,  four  arms,  and  four  legs,  and  two  bodies 
united  by  the  thoraces." 

It  is  practically  certain  that  the  female  monster  came  from  the 
ovary  opposite  to  that  from  which  the  single  male  child  did. 

Dr.  W.  Krusen^  of  Philadelphia  has  described  a  case  of 
triplets  in  the  right  Fallopian  tube.  They  were  of  only 
two  months'  development,  and  no  sex  was  given.  Compare 
also  Dr.  Russell  Andrews'  case  of  male  twins  in  the  right 
Fallopian  tube  (p.  71). 

Triplets  follow  the  rule  of  twins — that  owing  to  the 
rather  larger  right  ovary  there  are  more  boys  than  girls 
produced,  the  commonest  occurrence  being  2  boys  and  i 
girl,  this  combination  being  twice  as  numerous  as  any  other 
combination.  Freureisz,^  in  over  thirty  years'  experience, 
met  with  four  cases  of  2  boys  and  i  girl,  but  only  one  case 
of  2  girls  and  i  boy.  It  therefore  corroborates  and  explains 
the  statement  of  Saniter  quoted  by  Williams,'^  that  "  in 
triplet  pregnancy  the  children  are  usually  derived  from  two 
ova — one  from  one,  and  two  from  the  other  " — because 
twin  boys  from  one  ovum  are  far  commoner  than  twin  girls 
from  one  ovum;  and  a  case  of  triplets  in  a  colleague's 
practice  bore  this  out,  the  two  boys  being  uniovular  twins, 
and  the  girl  was  from  a  different  and  distinct  ovum — from, 
I  maintain,  the  opposite  ovary. 

Compare  the  case  of  triplets  described  in  the  note  on  p.  145. 

Dr.  Voron^  describes  a  case  of  triplets  with  two  girls  and 
a  boy,  who  was  the  last  born.     There  were  three  distinct 

^  "  Indiana  Med,  Journ.,"  April,  1899. 
2  "  Brit.  Med.  Journ./'  Jan.  1902,  p.  43. 
^  Freureisz,  Gynaecologia  No.  4,  1902. 
*  Williams,  op.  cit.,  p.  327. 

^  Dr.  Voron  in  "  Bull,  de  la  Soc.  d'Obstet.  et  Gynecol,  de  Paris,"  June, 
1912. 


140  THE  CAUSATION  OF  SEX 

cords  inserted  marginally  into  a  single-looking  placenta. 
"  There  was  a  bag  of  membranes  for  each  foetus."  In- 
jection of  the  umbilical  arteries  with  three  different  colours 
showed  "  there  was  no  vascular  communication  between 
the  placentae,"  "  the  coloured  areas  being  distinct  and 
sharply  limited."  This  therefore  showed  that  the  preg- 
nancy was  due  to  the  fertilisation  of  three  distinct  ova, 
"  with  subsequent  fusion  of  the  adjacent  parts  of  the  three 
placentae."  I  should  have  expected  two  corpora  lutea 
in  the  left  ovary,  and  one  in  the  right. 

Almost  identical  with  the  above  was  the  only  case  of 
triplets  I  have  personally  attended. 

There  were  2  girls  and  i  boy,  but  with  three  separate 
and  distinct,  not  fused,  placentae,  each  following  its  child's 
birth.  Here,  too,  three  distinct  ova  had  certainly  been 
fertilised — I  say  two  from  the  left  ovary  and  one  from  the 
right. 

Quadruplets. — If  both  ovaries  give  rise  to  twins,  we 
get  quadruplets ;  or  if  one  ovary  gives  triplets  and  the  other 
a  single  birth,  as  in  a  case  by  Simpson,  3  males  and  i  female. 
Here  the  right  ovary  must  have  ruptured  two  G.  Fs.,  one 
of  which  contained  two  ova,  or  else  had  a  double  germ  in 
one ;  while  the  left  ovary  supplied  a  single  ovum  only. 

If  all  four  children  are  the  same  sex,  it  is  possible  only 
two  G.  Fs.  are  present,  both  G.  Fs.  containing  two  ova;  or 
one  G.  F.  with  two  ova,  the  other  G.  F.  having  one  ovum  but 
a  double  germ.  If  there  were  three  G.  Fs.  the  arrangement 
is  quite  simple. 

It  is  possible  for  one  G.  F.  to  supply  quadruplets;  the 
children  would  be  all  the  same  sex.  The  G.  F.  would  then 
contain  two  ova,  and  each  ovum  a  double  germ. 

The  following  case  is  very  suggestive,  from  the  appear- 
ances of  the  placentae,  of  the  origin  from  the  two  ovaries 
of  two  ova  each  to  form  the  quadruplet  birth : 

M.  Etchecoin}  reported  a  case  of  quadruplets: 

"  The  mother  had  borne  her  first  child  nineteen  months  before 
she  was  dehvered  prematurely,  at  the  fifth  month,  of  4  infants — ■ 
2  males  and  2  females.     There  were  four  placentae  adherent  in  pairs." 

^  "  British  Medical  Journal,"  October  19,  1901,  p.  1166. 


MULTIPLE  PREGNANCY  141 

The  following  case  proves  very  decisively  that  the  one 
ovary  produced  the  male  child,  and  the  other  ovary  the 
three  females: 

Baudouin,  in  the  "  Paris  Medical  Gazette,"  describes  a 
recent  delivery  of  quadruplets,  in  which — 

"  one  ovum  contained  three  foetuses,  two  of  them  forming  a  sterno- 
pagus  {i.e.,  were  joined  together  at  the  chest),  aU  of  the  female  sex. 
After  their  deUvery  a  second  bag  of  waters  ruptured,  and  a  still-born 
male  child  followed." 

There  were  thus  two  ova  only. 
Dr.  Lloyd  Roberts  ^  reports  a  case  of  quadruplets — 

"  all  females.  Placenta  was  single.  Four  cords  were  distinct.  A 
single  chorion  enclosed  four  amniotic  sacs." 

They  were  therefore  derived  from  one  ovum,  and  therefore 
from  one  ovary — I  should  maintain  the  left. 

Dr.  Clifford  White^  reports  a  case  of  3  males,  i  female. 
Two  males  were  uniovular  twins  and  stillborn ;  the  other  boy 
and  the  girl  were  alive.  The  males  were  born  by  the  vertex, 
the  female  by  the  breech.  So  the  four  children  came  from 
three  ova. 

Dr.  Nijhoff,^  of  Groningen  (Netherlands),  reports  a  case  of 
quintuplets — 4  girls  and  i  boy.  Three  of  the  girls  were 
derived  from  one  ovum,  and  represented  uniovular  triplets; 
while  the  other  girl,  and  the  boy,  arose  from  two  separate 
ova. 

"  The  placenta  consisted  of  one  continuous  cake.  At  the  foetal 
side  five  separate  umbilical  cords  were  inserted,  each  in  a  distinct 
sac  formed  by  the  foetal  amnion.  Three  of  these  sacs  were  enclosed 
by  a  common  chorion.     The  two  others  had  a  separate  chorion." 

This  is  direct  evidence  of  fertilisation  of  three  ova,  and  I 
maintain  the  girls  were  derived  from  the  left  ovary  and  the 
boy  from  the  opposite  one. 

Baudouin,"^  in  discussing  sextuplets,  brings  out  the  fact 
that,  as  in  twin  births,  the  number  of  boys  far  exceeds  the 
girls.     Thus  in  one  case  all  the  six  children  were  boys;  in 

1  "  Journal  of  Obstetrics  and  Gynaecology,"  vol.  iii.  1903,  p.  91. 
.2  "  Proc.Roy.  Soc.  of  Med.,"  January  1910,  vol.  iii.,  p.  79. 
■^  Ibid.,  July  1904,  vol.  vi.  p.  32. 
*  Ibid.,  vol.  vi.  p.  52. 


142  THE  CAUSATION  OF  SEX 

another  case  4  boys  and  2  girls;  while  another  was  5  boys 
and  I  girl.     Thus  three  cases  give  15  boys  to  3  girls  ! 

It  will  thus  be  seen  that  plural  pregnancies  entirely  sup- 
port my  theory;  and  no  theory,  such  as  either  nutrition 
theories;  infrequency  or  frequency  of  intercourse  theories; 
or  strong  versus  weak  spermatozoon  theories ;  or  the  relative 
vigour  theory,  or  even  the  relative  age  theory  of  the  parents, 
can  possibly  explain  the  occurrence  of  boy  and  girl  or 
"  pigeon-pair  "  twins,  to  say  nothing  of  triplets  and  quadru- 
plets. This  fact  also  disproved  Schenk's  hypothesis;  for 
if  an  ovum  in  a  woman,  whose  urine  through  dieting  habitu- 
ally contained  sugar,  invariably  developed  when  fertilised 
into  a  girl,  and  the  presence  of  that  sugar  rendered  the  birth 
of  a  boy  impossible,  how  could  any  woman  be  pregnant 
with  both  a  boy  and  a  girl  at  the  same  time,  or  with  two 
of  each  ?  In  fact,  a  preliminary  careful  study  of  plural 
pregnancy  would  have  prevented  many  theories  of  the  causa- 
tion of  sex  ever  being  broached. 

The  varying  arrangement  of  the  foetal  membranes,  and 
the  fact  that  conjoined  twins  are  always  of  the  same  sex, 
are  both  only  satisfactorily  explicable  by  the  present 
theory. 

Close  study  of  plural  pregnancy  demonstrates  clearly  that 
such  an  occurrence  must  be  ascribed  to  the  mother  and  not 
to  the  father.     , 

We  know  that  many  million  more  spermatozoa  are  pro- 
vided every  time  {Lode  estimated  them  as  over  200,000,000 
in  a  single  ejaculation)  than  are  necessary  to  simply  fertilise 
the  normal  single  monthly  provided  ovum. 

If,  however,  for  some  reason,  probably  anatomical,  more 
ova  are  regularly  provided,  we  must  expect  plural  preg- 
nancies. Puech  definitely  alleges  "  superior  development 
of  the  ovaries  "  as  the  cause  of  the  simultaneous  develop- 
ment of  multiple  ova,  and  here  we  may  recall  that  a  quite 
healthy  ovary  has  been  found  which  measured  3I  in.  in  its 
long  diameter,  while  the  average  is  ij  in.  We  should 
expect  that  ovary  to  provide  more  than  the  normal,  one 
ovum  at  a  time. 

It  is  quite  evident  that,  if  the  amount  of  ovarian  tissue 


MULTIPLE  PREGNANCY  143 

capable  of  supplying  ova  is  increased  in  amount,  we  must 
expect  an  increased  production  of  ova.  So  that  unusually 
large  ovaries  lead  to  an  unusually  large  number  of  ova 
being  supplied,  and  this  extra  or  "  superior  development  " 
of  the  sexual  glands  is  in  my  experience  undoubtedly 
inherited;^  there  are,  indeed,  many  reasons  for  believing 
that  this  excessive  uberty  was  formerly  the  rule,  while  the 
degree  of  comparative  infertility  of  modern  woman  is  a 
result  of  the  constant  repression  of  her  natural  instincts, 
a  sacrifice  of  her  health  on  the  altar  of  fashion  and  financial 
convenience. 

Hellin,  quoted  by  Whitridge  Williams,^  discussing  multiple 
pregnancy,  states  that  "  the  ovaries  of  women  who  have  had 
a  number  of  multiple  pregnancies  contain  an  excessive 
quantity  of  ova."  Accordingly,  "  the  condition  is  probably 
due  to  the  maturation  each  month  of  several  ova,  instead 
of  one,  as  is  generally  the  rule."  And  I  here  recall  that 
normally  the  right  ovary  is  practically  always  a  little  larger 
than  the  left,  and  thus,  supplying  rather  more  right  or 
male  ova,  we  get  the  normally  slightly  higher  birth-rate 
of  106  boys  born  compared  to  100  girls. 

That  it  is  the  woman  who  is  responsible  for  plural  preg- 
nancies is  clearly  shown  by  the  following  case  reported  by 
Vortisch^:  A  woman  by  her  second  husband  gave  birth  to 
sextuplets,  5  boys  and  i  girl;  by  her  first  husband  she  "  had 
previously  given  birth  to  twins,  quadruplets,  and  triplets  in 
successive  pregnancies."  That  is,  15  children  in  four 
pregnancies.  The  maternal  origin  of  multiple  births  is 
thus  evident,  there  being  two  different  husbands. 

This  contention  is  borne  out,  too,  by  the  cases  we  fre- 
quently read  of,  the  woman  having  twins,  or  other  form  of 
plural  pregnancy,  repeatedly;  thus  Dr.  Lloyd  Roberts,"^  in 
1893,  related  a  case  of  a  woman  having  twins  fifteen  times. 
In  my  own  practice  the  following  cases  have  come  under 
notice:  A  woman,  Mrs.  M.  McL.,  had  twin  boys  seven  times 
over,  besides  four  single  male  births — i.e.  18  boys — and  oddly 

1  It  is  comparable  to  the  high  egg-laying  strains  of  fowls,  for  hens  which 
lay  from  260  to  290  eggs  per  annum  can  now  be  obtained. 

2  W.  Williams,  op.  cit.,  1913,  p.  369. 

2  Quoted  in  "Journ.  Obstet.  and  Gynaecology,"  July  1904,  vol.  vi.  p.  53. 
*  "  Lancet,"  August  1893. 


144  THE  CAUSATION  OF  SEX 

they  were  preceded  by  6  girls  before  a  boy  was  born.  She 
had  24  children  in  all. 

Mrs.  T.  W.  had  twins  on  three  occasions,  two  boys  each 
time;  while  Mrs.  J.  B.  and  Mrs.  A.  P.  both  had  twins  (boy 
and  girl)  on  two  separate  occasions.  Mrs.  W.  A.  T.  was 
delivered,  in  191 2,  by  me,  of  triplets,  two  girls  and  a  boy, 
followed  eighteen  months  after  by  twin  boys. 

Dr.  G.  H.  Napheys^  records  a  case  where  a  woman  had 
for  her  first  child  a  girl,  followed  by  twin  boys  on  four 
occasions,  making  9  children  in  all;  while  Dr.  W.  R.  Dix^ 
reported  a  case  of  a  Mrs.  M.,  aged  thirty,  having  twins  twice 
over,  her  mother  having  also  had  twins  twice,  her  sister 
twins  once,  and  her  aunt  twins  once. 

Baudouin^  reported  14  boys  in  three  deliveries :  first  trip- 
lets, then  quintuplets,  followed  by  sextuplets.  All  the 
children  were  males  ! 

Other  recorded  cases  are  seven  times  twins  and  two  single 
births;  or  from  Anvers,  near  Neuchatel,  a  case  of  four 
times  twins,  followed  by  triplets;  or  the  case  at  Belgrade 
of  triplets  followed  by  sextuplets;  or  from  Madrid,  triplets 
followed  by  quintuplets. 

The  above  cases  all  therefore  support  the  view  that 
plural  pregnancy  is  due  to  maternal  causes. 

The  only  recorded  case  I  have  been  able  to  find  definitely 
pointing  to  the  father  as  the  cause  was  mentioned  in  the 
**  Lancet.""*  It  is  the  historical,  unique,  and  probably 
apocryphal  case,  dating  from  1753,  of  the  Russian  peasant 
Kinlow.  He  was  twice  married,  and  had  72  children; 
though  Dr.  Napheys,^  who  also  mentions  this  case,  gives 
the  number  as  90  children  !  He  had  57  children  by  his 
first  wife,  four  times  4  infants,  seven  times  3,  and  ten  times 
2  at  a  birth.  By  the  second  wife  he  had  triplets  once,  and 
twins  six  times.  This  astonishing  case  seems  to  point  to 
the  husband  or  male  being  responsible;  it  is  quite  the 
exceptional  case,  however. 

1  Dr.  G.  H.  Napheys,  "  The  Physical  Life  of  Woman,"  1872,  p.  134. 

2  Dr.  W.  R.  Dix,  "  Brit.  Med.  Journ.."  Jan.  9,  1904,  p.  75. 

3  Baudouin,  loc.  cit. 

4  "  Lancet,"  Jan.  28,  1905,  p.  243. 

5  Napheys,  op.  cit.,  1872,  p.  133. 


MULTIPLE  PREGNANCY  145 

Among  cows  and  sheep  plural  births  are  not  a  very  un- 
common occurrence,  but  certain  individual  animals  are 
well  known  nearly  always  to  have  more  than  the  normal 
single  offspring.  They  have  probably  extra  well- developed 
ovaries.  With  sheep,  twins  very  often  are  born,  but  some 
have  three  or  even  four  lambs  at  a  birth.  Mares  rarely 
have  more  than  one  at  a  birth. 

A  case  of  triplets,  recently  delivered  in  this  neighbourhood, 
confirms  Sanitev's  opinion;  the  triplets  were  all  three  boys  with 
only  two  placentae. 

The  first  two  boys,  footling  born,  being  uniovular  twins,  were 
followed  by  their  single  placenta,  the  cords  being  inserted  two 
inches  apart,  the  third  boy,  breech  born,  being  duly  followed  by 
his  placenta.  There  were  thus  only  two  ova  fertilised,  one  giving 
rise  to  twins  and  one  to  a  single  birth,  and  the  right  ovary  must 
have  supplied  them  both. 


10 


CHAPTER  XIX 

DOES  A  DISEASED  OVARY  LEAD  TO 
DISEASED  CHILDREN? 

It  is  a  remarkable  fact  that  in  many  families  containing 
both  boys  and  girls  we  find  that  all  the  children  of  one  or 
other  sex  are  in  some  way  or  other  affected:  they  may  be 
physically  affected  or  deformed,  or  else  mentally  deficient; 
while  the  children  of  the  other  sex  are  quite  normal. 

The  following  cases  of  insanity  are  very  remarkable,  and 
are  more  than  coincidences : 

Mrs.  W.  had  5  children,  thus:  ist  a  boy,  2nd  a  girl,  3rd 
a  girl,  4th  a  boy,  5th  a  boy.  The  three  sons  are  all  mentally 
very  deficient,  two  are  idiotic,  and  one  quite  insane.  The 
two  girls  are  quite  sane. 

Mrs.  P.  had  5  children:  ist  a  boy,  2nd  a  boy,  3rd  a  girl, 
4th  a  boy,  5th  a  boy.  The  four  sons  are  healthy  and  quite 
sane.     The  daughter  is  an  idiot. 

Mrs.  S.  had  3  children:  ist  a  boy,  2nd  a  girl,  3rd  a  boy. 
The  two  sons  are  insane;  the  girl  is  quite  sane. 

Note  that  the  unhealthy  or  abnormal  children  do  not 
follow  each  other;  the  birth  of  normal  children  of  the  oppo- 
site sex  takes  place  between  them. 

The  following  remarkably  confirmatory  case  I  take  from 
the  *'  Lancet,"  June  7,  1902: 

Drs.  Key  aval  and  Raviart  report  a  case  of  insanity  m  twin 
brothers  who  had  for  many  years  lived  quite  apart  from  one 
another.  The  mother  of  the  men  was  alive  and  well. 
Neither  men  had  had  syphilis,  and  both  were  temperate 
in  their  habits.  Both  were  married.  The  special  interest 
of  the  case  lies  in — 

(i)  The  twinship  of  the  brothers. 

(2)  The  absence  of  hereditary  antecedents  of  insanity. 

(3)  The  freedom  from  syphilis  and  alcoholism. 

(4)  The  fact  that  both  were  married  and  fathers  of 

children. 

146 


i 


EFFECTS  OF  DISEASED  OVARY  ON  ISSUE     147 

It  will  be  observed  that  the  two  patients  were  of  the  same 
sex,  and  hence  had  been  derived  from  ova  from  the  same 
ovary — evidently  the  right. 

In  these  cases  the  children  derived  from  one  ovary  only 
are  deaf  and  dumb: 

Mrs.  F.  had  3  children — ist  a  girl,  2nd  a  girl,  3rd  a  boy — 
in  this  order.  Parents  were  not  related  before  marriage. 
The  two  girls  are  normal;  the  boy  is  deaf  and  dmiib. 

Mrs.  G.  had  7  girls  and  no  boys.  Parents  not  related  or 
deaf  and  dumb.     All  the  girls  are  deaf  and  dumb 

In  these  cases  the  children  of  one  sex  are  blind : 

Mrs.  M.  L.  R.  had  4  children:  ist  a  boy,  2nd  a  girl,  3rd  a 

girl,   4th  a  boy.     Parents  not  related.     Both  boys  born 

blind;  both  girls  all  right. 

Mrs.  S.  had  4  children:  ist  a  boy,  2nd  a  boy,  3rd  a  girl, 

4th  a  girl.     Both  boys  born  blind;  both  girls  all  right. 

In  this  case  convulsions  occurred  only  in  the  boys : 
Mrs.  K.  had  16  children,  12  boys  and  4  girls,  thus:  First 
3  boys,  then  2  girls,  then  5  boys,  then  2  girls,  then  4  boys. 
The  four  girls  are  all  alive  and  have  had  no  fits.  All  the 
twelve  boys  have  had  fits  ;  seven  boys  died  actually  during 
a  fit,  the  eighth  just  after  one  concluded:  he  had  had 
several. 

We  thus  see  that  a  succession  of  defective  children  is 
broken  by  the  birth  of  a  child  or  children  of  the  other  sex; 
and  this  should  be  noted,  that  the  affected  children  are 
separated  chronologically  by  healthy  ones  of  the  other  sex, 
showing  the  cause  of  the  imperfection  is  not  a  temporary 
one  due  to  mental  distress,  or  illness,  or  **  maternal  im- 
pression "  on  the  mother's  part;  nor  can  it  be  some  general 
blood  disorder — e.g.  syphilis — or  else  the  children  of  both 
sexes  would  be  similarly  affected.  No,  some  local  cause: 
I  say  the  ovary  of  one  side  must  yield  defective  ova. 

In  the  following  cases  the  children  of  one  sex  only  are 
left-handed : 

Mrs.  H.  H.  Parents  not  related,  and  neither  left-handed. 
First  child,  girl,  not  left-handed;  second,  twin  boys,  both 
left-handed. 


148  THE  CAUSATION  OF  SEX 

Mrs.  H.  C.  had  7  children:  4  boys,  3  of  them  left-handed; 
3  girls,  none  left-handed. 

In  the  following  case  the  female  children  both  had  hare- 
lip, the  boy  was  unaffected: 

Mrs.  S.,  no  relation  to  her  husband,  had  3  children:  ist  a 
girl,  hare-lip;  2nd  a  boy,  normal,  no  hare-Hp;  3rd  a  girl, 
hare-lip.  This  case  is  interesting,  as  hare-lip  is  twice  as 
common  in  boys  as  girls. 

All  the  above  cases  lead  one  to  inquire,  does  a  diseased 
condition  of  one  ovary  which  does  not  prevent  ovulation, 
and  which  is  possibly  not  even  recognisable  by  the  micro- 
scope, lead  to  the  production  of  ova  which  are  imperfect 
or  diseased  ? 

In  cases  of  syphilis  it  is  admitted  that  the  ova  may  be 
affected  before  they  are  impregnated  even;  and  though 
this  disease  would  affect  the  ova  in  both  ovaries,  yet  it  is 
justifiable  to  suppose  that  one  ovary  may  be  affected  by 
some  congenital  peculiarity  or  disease,  not  a  blood  disorder, 
which  would  be  unilateral  in  its  effects.  Thus,  while  not 
arresting  ovulation  from  the  ovary,  the  ova  when  fertilised 
would  lead  to  a  diseased  or  structurally  deficient  child. 

Such  is  probably  the  explanation  of  the  case  described 
by  Tarnier  and  Budin  ■"•  of  a  woman  who — 

"  gave  birth  alternately  to  living  and  dead  children.  The  first 
child  was  living  and  healthy,  the  second  dead,  and  so  on,  until  the 
tenth  pregnancy.     It  was  born  alive,  however." 

In  the  following  case,  reported  by  Dr.  H.  R.  Andrews^^  a 
woman,  L.  S.,  aged  ^b,  with  no  history  of  syphilis,  gave 
birth  to  twins  prematurely — a  girl  and  a  boy. 

"  A  living  female  child  was  born,  followed  by  a  placenta  which 
presented  no  abnormal  macroscopical  appearance.  A  second  bag 
of  membranes  was  ruptured,  and  a  male  child  was  born,  followed  by 
an  enormous  placenta.  The  male  child  was  still-born,  it  was  uni- 
versally oedematous  and  dropsical.  Its  placenta  was  very  large, 
pale,  oedematous,  soft  and  friable." 

As  the  two  placentae  were  entirely  separate,  we  know 
that  the  two  ova  fertilised  were  also  separated  ones,  and  as 
the  sexes  were  different  I  ascribe  one  to  each  ovary  (the 

^  Quoted  by  Hirst,  op.  cit.,  p.  179. 

^  "  Trans.  Obstet.  Soc,"  vol.  xiiii.  1901,  pp.  169-71. 


EFFECTS  OF  DISEASED  OVARY  ON  ISSUE     149 

commonest  mode  of  origin  for  twins).  One  child,  the 
female,  however,  was  normal,  while  the  other  was  abnormal, 
showing  that  the  diseased  condition  of  the  male  child  was 
not  due  to  a  general  diseased  condition  of  the  mother  or  of 
her  womb,  or  else  both  children  would  have  been  similarly- 
affected,  as  they  would  have  probably  been  had  both  been 
derived  from  the  same  ovary.  Thus  we  have  proof  of  the 
origin  of  a  healthy  child  with  a  healthy  and  separate  placenta 
from  one  ovary,  while  the  ovum  from  the  opposite  ovary 
was  evidently  diseased,  and  so,  though  fertilised,  a  diseased 
child  and  placenta  followed  as  a  consequence. 

The  case,  therefore,  supports  the  theory  that  one  ovary 
may  yield  imperfect  or  diseased  though  fertilisable  ova, 
which  very  early  show  their  effects  by  a  diseased  condition 
of  both  child  and  "  after-birth." 

The  following  cases  seem  to  show  that  the  ova  may  be  so 
imperfect  from  an  ovary,  which  to  all  appearances  is  normal, 
that  the  children  from  that  ovary  always  die : 

Mrs.  B.  had  6  children — 3  boys  followed  by  2  girls,  then 
a  boy.  Both  girls  died  shortly  after  birth.  The  boys 
all  lived. 

Mrs.  W.  by  her  first  husband  had  4  children — 3  boys 
who  all  died,  and  a  girl  who  lives.  By  her  second  husband 
she  had  4  children — -3  boys  who  all  died,  and  a  girl  who  lives. 

This  hardly  seems  a  case  of  coincidence,  or  as  due  to  the 
greater  infantile  mortality  of  males. 

Mrs.  P.  had  3  boys,  5  girls.     All  the  girls  died  in  infancy. 

Mrs.  L.  had  6  boys,  all  died,  3  girls  lived,  thus — 

1st,  boy,  died.  2nd,  girl,  lived. 

3rd,  boy,  died.  4th,  girl,  lived. 

5th  and  6th,  boys,  died.  7th,  girl,  lived. 
8th  and  9th,  boys,  died. 

In  the  following  cases  the  ova  are  imperfect,  and  lead  to 
delicate  children,  who  do  not  necessarily  die,  but  they 
remain  the  delicate  ones  of  the  family,  thus — 

Mrs.  L.  S.  had  5  girls,  i  boy.  The  girls  are  all  strong  and 
healthy.  The  boy  is  very  delicate ;  he  was  the  fourth  child 
bom,  so  that  two  healthy  girls  succeeded  him. 


150  THE  CAUSATION  OF  SEX 

Mrs  T.  had  5  boys,  i  girl.  The  boys  are  healthy  and 
strong.  The  girl  was  deformed  and  a  cripple,  and  has  since 
died. 

Mrs.  M.  had  4  boys,  i  girl.  The  boys  are  healthy  and 
strong.  The  girl,  the  third  born,  is  delicate;  her  two 
younger  brothers  are  very  healthy. 

Mrs.  C.  L.  had  first  a  girl  insane,  then  5  boys  all  healthy, 
then  lastly  girl,  deHcate,  died  of  phthisis. 

This  diseased  condition  of  the  ova  is  supported  by  the 
description  by  Dr.  Mary  Dixon  Jones^  of  fatty  and  colloid 
disease  of  the  ova  in  the  ovary,  so  that — ■ 

"  In  advanced  cases  not  a  single  healthy  ovnm  is  found  in  the 
whole  ovary." 

We  can  thus  see  that  in  some  cases  a  few  of  the  ova  may 
be  perfect  while  the  majority  are  affected. 

Mrs.  W.  B.  had  6  children — ist,  2nd,  3rd,  boys  all  deaf 
and  dumb;  4th  a  girl,  normal;  5th  a  boy,  not  deaf  and 
dumb ;  6th  a  boy,  deaf  and  dumb. 

It  will  be  seen  that  the  female  child  was  healthy,  and  all 
the  males,  with  one  exception,  were  deaf  and  dumb;  so 
that  the  majority  of  the  male  ova  were  diseased  or  imperfect. 
That  the  condition  was  not  due  to  "  maternal  impression  " 
is  evident  from  the  fact  that  one  healthy  boy  was  born 
between  two  deaf  and  dumb  ones. 

Mrs.  C.  C.  had  8  children — ist,  boy,  normal;  2nd,  boy, 
deaf  and  dumb;  3rd,  boy,  normal;  4th,  boy,  deaf  and  dumtJ; 
5th,  girl,  deaf  and  dumb;  6th,  girl,  normal;  7th,  boy, 
normal;  8th,  girl,  normal. 

C.  /..  Bond  reported  in  the  "  Lancet,"  August  1905,  a 
case  where  healthy  parents  had  14  children — ^thus:  First 
3  girls,  normal;  then  6  boys,  all  deaf  and  dumb;  then  4  more 
girls,  normal;  and  lastly  a  normal  boy. 

The  following  very  interesting  case  also  supports  this 
view,  of  one  healthy  ovary,  and  the  other  ovary  containing 
only  a  small  proportion  of  healthy  ova. 

Dr.  J.  W.  Ballantyne^  describes  the  case  of  a  woman  who 
had  her  children  thus — 

1  Dr.  Mary  D.  Jones,  quoted  by  Macnaughton- Jones,  op.  cit.,  pp.  654,  657. 
~  Ballantyne,  "Journal  of  Obstetrics  and  Gynaecology,"  vol.  ii.,  Dec, 
1902,  p.  529. 


EFFECTS  OF  DISEASED  OVARY  ON  ISSUE     151 

I  St,  boy,  living;  2nd,  boy,  living;  3rd,  abortion,  2nd  to  3rd  month, 
(probably  male) . 

4th,  girl,  hydrocephalic,  dead. 

5th,  girl,  normal,  living, 

r)th,  girl,  anencephalic,  dead. 

7th,  girl,  "  delicate,"  died  at  5  weeks. 

8th,  girl,  deformed  and  premature,  died  3  days  old,  commencing 
hydrocephalus. 

9th,  girl,  normal,  living. 

Here  we  have  the  male  children  normal  and  living, 
followed  by  the  birth  (with  an  abortion  between,  which  was 
possibly  a  male  embryo)  of  six  female  children,  only  two 
of  which  were  normal  and  lived. 

Of  the  remaining  four,  three  at  least  were  monsters, 
whilst  the  fourth,  of  which  few  particulars  appear,  was 
**  delicate  from  the  first  "  and  soon  died. 

Surely  some  local  as  distinct  from  general  condition  must 
have  accounted  for  this  string  of  female  monstrosities.  I 
ascribe  it  to  defective  ova  in  one  of  her  ovaries — the  left. 

Hegar  reported  a  case  of  removal  of  a  malignant  tumour 
of  one  ovary,  subsequent  pregnancy,  and  birth  of  a  deformed 
child;  the  remaining  ovary  also  being  then  found  to  be 
sarcomatous  and  inoperable.  Here  both  ovaries  are  dis- 
eased, and  though  an  ovum  is  fertilised,  yet  the  child  is 
born  deformed,  so  that  the  diseased  ovum  irom  the  diseased 
ovaries,  which  is  not  stated,  gave  a  diseased  child. 

Dr.  Ballantyne^  reports  a  case  where  a  woman  had  ist 
child,  girl,  deformed  (spina  bifida);  2nd  and  3rd  children, 
boys,  normal  and  healthy;  4th  child,  girl,  deformed  (ini- 
encephalic  monster). 

This  case  looks  as  though  the  left  or  female  ovary  had 
supplied  diseased  ova,  the  healthy  males  being  born,  in 
between  the  deformed  female  ones,  from  healthy  ova  from 
the  other  or  right  ovary. 

In  a  case  of  my  own,  Mrs.  R.  had  first  a  girl,  healthy; 
then  a  boy  with  spina  bifida;  then  another  girl,  healthy. 
Here  a  deformed  male  appears  between  two  normal  females. 

Dr.  J.  E.  Blomfield  reports  in  the  "  British  Medical 
Journal,"  April  11,  1903,  a  case  of  a  woman  who  had  two 
children,  two  years  or  so  apart.     Both  were  boys,  and  both 

^  "  Manual  of  Antenatal  Pathology:  The  Embryo,"  p.  273,  1904.     , 


152  THE  CAUSATION  OF  SEX 

were  malformed  in  an  almost  identical  manner.  Surely 
here  the  right  or  male  ovary  had  provided  abnormal  ova 
on  the  two  occasions. 

Dr.  Robert  Hutchison^  reported  a  case  of  twins,  with  male 
child  healthy,  and  the  female  achondroplasic. 

/.  Howell  Evans^  has  recorded  a  case  where  the  girls 
were  affected  with  helical  fistulae  and  accessory  auricles, 
while  the  sons  were  quite  normal. 

And  a  patient  of  my  own,  Mrs.  C.  B.  D.,  had  two  girls 
who  were  identically  deformed,  having  only  a  little  finger 
and  diminutive  thumb  on  each  hand,  and  only  the  little 
and  big  toe  on  each  foot.     She  had  no  son. 

In  the  following  extracts  we  see  that  both  Kossmann  and 
Marchand  credit  diseased  ova  as  occurring  in  the  ovaries, 
and  prior  to  fertilisation.  Thus,  Dr.  R.  Andrews^  quotes 
Kossmann  as — 

"  noting  the  frequency  with  which  the  ovaries  present  some  abnormal 
appearance  in  cases  of  tubal  pregnancy,  and  suggesting  that  these 
pathological  ovaries  may  have  supplied  pathological  ova." 

And  similarly  Marchand,  quoted  by  Dr.  Cuthbert  Lockyer,^ 
says : 

"  The  influence  of  the  maternal  organism  makes  itself  felt  upon 
the  ovum  in  the  ovary,  the  latter  transmitting  any  peculiarities  it 
may  possess  to  the  developing  ovum.  These  tendencies  to  disease 
show  themselves  during  the  development  of  the  ovum  in  titer o. 
Twin  pregnancies,  in  which  one  ovum  develops  normally  and  the 
other  degenerates  into  a  mole,  afford  an  argument  in  favour  of 
the  view  that  the  diseased  ovum  acquired  its  pathological  tendencies 
whilst  it  was  within  the  ovary.  That  ova  may  be  primarily  diseased 
seems  very  probable." 

1  should  maintain  that  the  healthy  child  in  such  a  twin 
pregnancy  usually  came  from  one  ovary,  while  the  diseased 
one  came  probably  from  the  opposite  ovary;  though  it  is 
possible  to  have  some  healthy  and  some  unhealthy  ova  in  the 
same  ovary,  as  in  a  case  reported  by  Birnbaum^  and  quoted 
by  Dr.  Stevens,  where  a  woman  in  a  twin  pregnancy  had 

^  "  Proc.  Roy.  Soc.  of  Med.,"  December  1909,  vol.  iii.,  p.  41. 

2  Ihid.,  January  1909,  vol.  ii.,  p.  102. 

3  "  Journal  of  Obstetrics  and  Gynaecology,"  vol.  iv.,  Sept.  1903,  p.  290. 

4  "  Trans.  Obstet.  Soc,"  vol.  xlv.  1903,  p.  495. 

5  "  Journal  of  Obstetrics  and  Gynaecology,"  vol.  v..  May  1904,  p.  475. 


EFFECTS  OF  DISEASED  OVARY  ON  ISSUE     153 

"  a  vesicular  mole  and  a  healthy  foetus,"  so  that  one  ovum 
was  diseased  and  one  healthy.  Post  mortem  both  corpora 
lutea  were  in  the  same,  the  left  ovary;  and  whilst  one  of 
these  was  quite  normal  the  other  was  diseased — proof 
indeed  that  one  ovary  can  give  both  healthy  and  unhealthy 
ova. 

Most  abnormalities  are  commoner  in  male  than  in  female 
children — e.g.  colour-blindness  affects  the  male  sex  almost 
entirely,  as  also  does  double  hare-lip;  but  congenital  dis- 
location of  the  hip  is,  Dr.  Ttibby^  states,  "seven  times  as 
common  in  females  as  in  males."  For  further  details  of 
variations  in  the  respective  liability  of  the  sexes  to  other 
abnormalities  I  refer  the  reader  to  Dr.  Havelock  Ellis, 
"  Man  and  Woman,"  chap,  xvi.,  though  he  does  not  specify 
any  cause  therefor. 

It  is  evident  that  the  condition  of  health  or  want  of 
health  in  a  woman  more  or  less  affects  all  her  organs,  and 
therefore  her  ovaries  and  their  contained  ova  are  influenced 
by  her  state  of  health  or  disease;  hence  the  first  step  in 
eugenics  must  be  the  improvement  of  the  general  health  of 
the  mother,  so  that  her  ova  are  quite  healthy. 

Certainly  this  subject  of  the  deformity,  disease,  or  death 
of  all,  or  most,  of  the  children  of  one  sex  in  a  family,  the 
children  of  the  other  sex  being  perfect,  opens  up  a  wide 
field  for  investigation. 

^  A.  H.  Tubby,  "  Clinical  Journal,"  July  i,  1903. 


CHAPTER  XX 

HERMAPHRODITISM 

The  subject  of  hermaphroditism  has  very  shortly  to  be 
considered  in  connection  with  this  inquiry  into  the  cause 
*  of  sex. 

True  hermaphroditism  may  be  defined  as  the  presence  in 
one  individual  of  the  reproductive  organs  of  both  sexes, 
in  a  condition  of  functional  activity. 

In  this  strict  sense  of  the  term,  hermaphroditism  is  a 
condition  which  does  not  exist  in  the  human  species,  for, 
as  Sir  J.  Bland-Sutton  ^  says — 

"  no  example  has  yet  been  recorded  in  the  human  family  of  a  fimc- 
tional  ovary  coexisting  with  a  functional  testis." 

Many  individuals  are  bom  in  whom  the  external  genitals 
are  so  imperfectly  developed  and  deformed  that  it  may  be 
difficult  to  say  to  which  sex  they  belong;  they  certainly  do 
not  possess  the  complete  and  active  sexual  organs  of  both 
sexes,  and  so  are  not  true  hermaphrodites:  they  are  known 
as  false  or  pseudo-hermaphrodites — the  "  Will- Jill "  of  the 
laity.  These  false  hermaphrodites  may  appear  to  possess 
the  genital  organs  of  both  sexes,  but  they  do  not  really 
do  so. 

Dr.  G.  F.  Blacker  ^  says : 

"  If  functional  activity  for  the  two  kinds  of  glands  is  insisted  upon, 
it  is  most  unlikely  that  any  case  of  true  hermaphroditism  will  ever 
be  met  with  in  man," 

So  that  we  may  say  that  the  true  test  of  a  female  is  the 
presence  of  functional  ovaries,  of  a  male  the  presence  of 
active  testicles,  and  the  malformed  external  genitals  of  the 
pseudo-hermaphrodite  are  no  guide  to  the  nature  of  the 
internal  generative  organs. 

^  "  Diseases  of  Ovaries,"  1896,  p.  7. 

2  Blacker,  "  Trans.  Obstet.  Soc,"  1896,  p.  265. 

154 


I 


HERMAPHRODITISM  155 

If  in  conjunction  with  modified  external  genitals  there 
be  a  female  gland  on  one  side  and  male  on  the  other,  then 
one  or  other  set  are  functionless,  so  that  one  or  other 
characteristic  predominates;  hence  the  pseudo-hermaphro- 
dites are  either  male  or  female,  and  though  they  are  generally 
sterile  they  are  certainly  not  a  third  sex;  had  they  been,  I 
should  have  expected  there  to  be  a  third  ovary,  possibly 
situated  in  midline  of  body ;  but  such  an  occurrence  is  quite 
unknown. 

A  pseudo-hermaphrodite  is  an  abnormality  due  to  a 
developmental  error;  the  condition  is  not  confined  to  the 
human  species,  but  occurs  in  some  animals,  especially  in 
pigs,  cows,  and  goats. 

It  is  a  remarkable  fact  that  a  cow  calf  twin-born  with  a 
bull  calf  is  frequently  a  pseudo-hermaphrodite,  and  is  often 
but  certainly  not  always  sterile:  it  is  popularly  known  as 
a  "  free-martin."  On  the  assumption  presumably  that 
what  applies  to  the  vertebrata  must  also  always  apply  to 
women — an  assumption  which  I  strongly  deprecate  and 
deny — it  has  been  believed  by  many  that  the  girl  twin- 
born  with  a  boy  would  also  be  a  free-martin  and  sterile. 
Such,  however,  is  not  a  fact,  and  there  are  abundant  cases 
on  record  of  women  in  cases  of  pigeon-pair  twins  being 
fruitful  and  bearing  children. 

In  one  instance  with  which  I  am  acquainted,  a  woman 
twin-born  with  a  man  had  had  nine  children,  four  boys 
and  iive  girls;  while  in  another  case  both  the  man  and 
woman  twin-born  had  children  of  both  sexes  when  they 
married,  showing  that  neither  brother  nor  sister  was  sterile. 
Further,  in  "  The  British  Medical  Journal "  of  November 
1902,  p.  1691,  a  case  is  mentioned  of  a  man,  the  co-twin 
of  a  woman,  marrying  a  woman  who  was  the  co-twin  of 
another  man — i.e.  the  man  and  woman  of  two  different 
pairs  of  pigeon-pair  twins  married  and  had  a  child;  which 
also  conclusively  shows  that  neither  child  in  a  case  of  different 
sexed  twins  is  necessarily  or  even  usually  sterile:  cf.  also 
**  The  British  Medical  Journal,"  November  29,  1902,  and 
December  20,  p.  1940.  Most  human  pseudo-hermaphro- 
dites are  single  births;  1  have  found  no  example  of  twins 
being  both  hermaphrodites. 


156  THE  CAUSATION  OF  SEX 

It  is  evident,  from  the  fact  to  which  I  have  called  attention 
— viz.  that  the  child  is  born  with  definite  sexed  ova  already 
in  her  ovaries — that  the  idea  that  the  early  condition  of 
the  sexual  organs  in  mankind  is  one  of  embryonic  herma- 
phroditism can  no  longer  be  supported.  It  is  partially 
disproved,  too,  from  the  fact  that  Nagel  has  distinguished 
the  rudimentary  testicle  from  the  rudimentary  ovary  in 
an  embryo  of  only  five  weeks'  growth. 

To  enter  into  a  minute  description  of  the  varying  deformi- 
ties and  peculiarities  of  different  false  hermaphrodites  is 
quite  unnecessary,  and  to  find  a  reason  for  their  abnormah- 
ties  of  development  does  not  come  within  the  scope  of  this 
book,  neither  would  it  help  to  solve  this  question  of  the 
cause  of  sex. 


CHAPTER  XXI 

CASES  THOUGHT  TO  DISPROVE  THE  THEORY 

Among  the  disbelievers  of  my  theory  the  greatest  rehance 
in  supporting  their  scepticism  has  been  placed  on  those 
cases  (after  all  only  a  quite  small  number)  in  which  an 
ovary  or  an  ovarian  tumour  has  been  removed  by  operation, 
and  the  woman  has  subsequently  given  birth  to  a  child,  whose 
sex  corresponded  to  the  ovary  which  had  been  removed. 
In  a  few  cases  a  woman  has  even  had  twins,  boy  and  girl, 
after  the  removal  of  one  ovary. 

It  is,  of  course,  at  once  evident  that  one  part  of  my  theory 
of  the  causation  of  sex  entirely  fails  if  this  rare  occurrence 
cannot  be  fully  explained. 

The  explanation  is,  shortly,  that  it  is  very  difficult,  and 
often  impossible,  to  be  sure  that  all  ovarian  tissue  has  been 
removed  by  the  operation  of  taking  away  an  ovary  or  an 
ovarian  tumour. 

It  is  not  usual  to  remove  normal  ovaries,  but  even  when 
removing  an  apparently  normal  ovary  it  is  quite  easy  to 
leave  a  portion  of  ovarian  tissue  in  the  stump  or  pedicle — 
i.e.  in  the  ovarian  or  utero-ovarian  ligament  which  runs 
from  the  ovary  to  the  side  of  the  uterus.  This  ligament 
is  normally  about  an  inch  to  an  inch  and  a  quarter  long. 
I  have  seen  one  of  the  most  experienced  of  abdominal 
surgeons  unintentionally  leave  ovarian  tissue  in  the  pedicle 
when  doing  hysteropexy,  the  normal  ovary  being  removed 
to  facilitate  reposition  of  the  uterus. 

Mr.  Alban  Doran^  states  he  had  "  more  than  once  de- 
tected ovarian  tissue  in  the  ovarian  ligament  close  to  the 
uterus  and  far  from  the  anatomical  ovary,"  so  that  though 
the  anatomical  ovary  be  removed,  some  ovarian  tissue  is 
still  left  behind  in  the  pedicle  stump. 

^  "  Trans.  Obstet.  Soc,"  vol.  xlvi.,  1904,  p.  102. 
^57 


158  THE  CAUSATION  OF  SEX 

If  the  pedicle  be  long,  owing  to  stretching  and  dragging 
out  of  the  ovarian  ligament  by  a  tumour,  we  cannot  say  how 
far  along  it  ovarian  tissue  extends,  and  so  we  are  quite  likely 
to  leave  some  ovarian  tissue  in  it  when  we  divide  it  to  re- 
move the  tumour;  if  the  pedicle  be  short,  as  Doran^  says, 
**  the  operator  rightly  dreads  slipping  of  the  ligature,  and 
so  is  apt  to  make  it  too  long  and  leave  a  piece  of  ovary 
behind/' 

Dr.  J.  Halliday  Groom  ^^  confirms  this:  he  says,  "it  is 
often  difficult  to  state  for  certain  that  the  whole  of  the  ovary 
has  been  removed;  a  small  portion  may  be  left  in  the 
pedicle." 

In  cases  of  ovariotomy  performed  during  pregnancy, 
Dr.  W.  Walter  ^  says — 

"  the  closer  to  the  uterine  waU  the  pedicle  was  ligatured,  the  greater 
the  chance  of  irritation  (of  the  uterus)  resulting  in  miscarriage, 
hance  the  pedicle  was  secured  as  far  from  the  uterine  wall  as  safety 
permitted." 

Here  we  see  a  reason  why  ovarian  tissue  is  sometimes  left 
behind  in  the  pedicle,  and  a  case  pubhshed  by  Baldwin  ^ 
proves  it.  The  patient  was  pregnant.  She  had  two 
ovarian  cysts,  which — 

"  had  become  adherent,  but  the  tumours  were  distinct,  and  each 
had  quite  a  long  pedicle.  Owing  to  the  known  fact  of  her  pregnancy, 
care  was  taken  to  avoid  any  manipulation  of  the  uterus." 

The  tumours  were  removed. 

She  has  had  two  other  children  since  the  operation,  but 
the  sex  is  not  given. 

It  is  evident  that  some  ovarian  tissue  was  not  removed,  for 
though  both  ovarian  tumours  were  removed,  she  became 
pregnant  twice  after  the  operation,  and  I  maintain  that  those 
children  were  of  the  same  sex  if  the  ovarian  tissue  was 
left  on  one  side  only ;  had  some  been  left  on  both  sides,  then 
it  is  possible  she  had  children  of  both  sexes— that  is,  either 
pigeon-paired  twins,  or  else  male  and  female  children  at 

1  Doran,  "  Journal  of  Obstetrics  and  Gynaecology,"  vol.  ii.,  1902,  p.  7. 

2  Halliday  Croom  in  "  AUbutt  and  Playf air's  Gynaecology,"  p.  343. 

3  Dr.  W.  Walter,   "  Journal  of  Obstetrics  and  Gynaecology,"  January 
1903,  vol.  iii.  p.  93- 

*  Baldwin,  op.  cit.,  vol.  iii.,  March  1903,  p.  264. 


CASES  THOUGHT  TO  DISPROVE  THEORY     159 

different  times — after  the  double  or  bilateral  ovariotomy 
had  been  performed. 

In  the  following  case,  reported  by  Dr.  R.  Stanshury  Sutton,^ 
the  patient  had  an  ovarian  tumour  on  each  side.  Double 
ovariotomy  was  performed,  i.e.  both  ovarian  tumours  were 
removed. 

"  This  operation  was  done  on  October  20,  1892.  On  June  10,  1894, 
the  patient  gave  birth  to  a  male  child.  Again,  on  February  25,  1896, 
she  was  delivered  of  a  male  child." 

Therefore  a  portion  of  an  ovary  must  have  been  left 
behind  in  the  abdomen,  and  of  whichever  ovary  it  was 
(I  maintain  it  was  a  portion  of  the  right  ovary)  the  fact 
remains,  that  that  portion  of  ovary  "  bred  true," — that  is, 
it  yielded  two  boys,  not  first  a  boy  and  then  a  girl.  This 
surely  cannot  be  looked  upon  as  a  coincidence. 

In  another  case,  Dr.  Balding,  after  ovariotomy  by  Spencer 
Wells  (whether  bilateral,  or  which  side  is  not  mentioned), 
delivered  a  patient  of  male  triplets — not  two  boys  and  a 
girl,  note.  That  is,  the  ovary  not  removed  yielded  three 
children,  all  the  same  sex.  I  contend  that  either  only  the 
left  ovary  was  removed,  or,  if  both  were  supposed  to  be 
taken  away,  a  piece  of  the  right  ovary  was  allowed  to  remain. 

Here  it  will  be  well  to  call  attention  to  a  paper  by  Dr. 
J.  H.  Dauber,''^  who  therein  shows  conclusively  the  reason 
why  patches  of  ovarian  tissue  are  often  to  be  found  in  the 
ovarian  ligament,  and  also  he  suggests  sometimes  in  the 
ovario-pelvic  ligament.  It  is  due  to  traction  on  the  ovaries, 
during  development,  by  the  muscle  fibres  in  the  ovarian 
ligaments. 

Besides  being  situated  in  these  ligaments,  there  is  very 
strong  reason  to  believe  ovarian  tissue  is  sometimes  to  be 
found  in  between  the  layers  of  the  broad  ligaments,  and 
unconnected  with  the  ovarian  ligaments,  or  ovary. 

Dr.  Dauber  ^  corroborates  thus : 

"It  is  generally  believed  either  that  accessory  ovaries,  or  addi- 
tional patches  of  ovarian  tissue,  like  accessory  thyroids  in  the  neck, 
may  exist  in  the  broad  ligaments  " ; 

1  Dr.  R.  S.  Sutton,  "  Geneva  Gynaecological  Congress,"  September  1896; 
and  "  Trans- American  Gynaecological  Society,"  1896,  p.  105. 

2  Dr.  J.  H.  Dauber,  "  Lancet,"  Jan.  28,  1905,  p.  224. 
^  Loc.  cit. 


i6o 


THE  CAUSATION  OF  SEX 


CASES  THOUGHT  TO  DISPROVE  THEORY     i6i 

and  a  case  reported  by  Baldwin^  proves  this  conclusively : 

"  On  July  15,  1893,  both  ovaries  and  tubes  were  removed.  No 
adhesions  were  encountered.  Sixteen  months  later,  in  November 
1894,  careful  examination  revealed  a  small  mass  of  tissue  to  the  left 
of  the  uterus.  When  this  was  pressed  upon,  a  sensation  was  ex- 
perienced similar  to  that  caused  by  pressure  upon  an  ovary." 

The  abdomen  was  again  opened : 

"  This  mass  of  tissue,  which  was  between  the  layers  of  the  left 
broad  ligament,  and  apparently  just  below  the  remains  of  the 
ovarian  ligament,  was  identified  and  removed.  It  was  about  the  size 
and  shape  of  a  small  Lima  bean,  and  presented  all  the  characteristics 
of  ordinary  ovarian  tissue.  No  other  ovarian  tissue  could  be  found 
at  any  other  point,  and  the  abdomen  was  closed.  Menstruation 
continued,  however,  showing  that  some  ovarian  tissue  still  remained 
somewhere." 

Let  it  be  noted  that  both  ovaries  are  definitely  stated 
to  have  been  removed,  yet  ovarian  tissue  was  found  and 
removed  from  between  the  layers  of  the  left  broad  ligament ; 
but  in  spite  even  of  this,  "  some  ovarian  tissue  still  re- 
mained," as  evidenced  by  the  return  of  menstruation. 

I  have  therefore  now  enumerated  three  possible  anatomical 
sites  in  which  ovarian  tissue  may  sometimes  be  found  in- 
dependently of  the  true  ovary,  and  therefore  the  removal 
of  the  whole  ovary  or  the  whole  of  an  ovarian  tumour, 
on  both  sides,  does  not  invariably  prevent  a  subsequent 
pregnancy. 

And  now  we  must  consider  the  possibility  of  a  super- 
numerary ovary. 

An  extra  or  third  true  ovary,  having  the  size,  shape, 
and  activity  of  the  normal  organ  separated  from  it, 
and  in  association  with  a  third  Fallopian  tube,  is  quite 
unknown. 

Accessory  ovaries,  however,  do  occur,  but  not  with  the 
frequency  which  Beigel  claimed  for  them. 

They  are,  Dr.  J.  W.  Ballantyne^  says,  "probably  con- 
stricted portions  of  the  normal  organs  which  have  been 
separated  at  an  early  period  in  the  development";  they 

^  Baldwin,  "  American  Journal  of  Obstetrics,"  December  1902,  quoted 
in  "  Journal  of  Obstetrics  and  Gynaecology,"  vol.  iii.,  March  1903,  p.  265. 

2  Ballantyne,  "  Allbutt  and  Playf air's  System  of  Gynaecology,"  1906, 
pp.  130,  131. 

II 


i62  THE  CAUSATION  OF  SEX 

occur,  he  says,  in  "  2  to  3  per  cent,  of  post-mortem  examina- 
tions." In  rare  cases,  "  the  ovary  has  been  found  divided 
into  two  nearly  equal  parts  by  such  a  constriction." 

Sir  J.  Bland-Sutton  ^  has  always  denied  the  existence  of  a 
true  third  ovary.  He  admits  of  ovaries  so  deeply  fissured 
that  a  "  portion  of  the  gland  is  almost  isolated,"  and  the 
ovary  '*  seems  to  consist  of  two  parts  united  by  a  narrow 
isthmus." 

Hence  it  must  be  possible  for  an  ovarian  tumour  to 
develop  in  one  part  and  not  the  other,  and  by  its  weight 
and  traction  to  gradually  elongate  this  isthmus,  so  that, 
when  operated  on,  the  isthmus  between  the  two  isolated 
parts  is  divided  by  scissors  instead  of  the  true  ovarian 
ligament,  and  therefore  a  piece  of  ovary  proper  is  left 
behind,  though  the  whole  ovarian  tumour  is  claimed  to 
be  removed. 

A  case  reported  by  Dr.  Galahin^  is  very  corroborative. 
Two  portions  of  the  ovary,  one  containing  a  tumour,  were 
separated  by  three-quarters  of  an  inch  of  ovarian  ligament. 
The  portion  nearest  the  uterus  was  the  unaffected  portion; 
"  on  the  ovarian  ligament,  close  to  the  angle  of  the  uterus, 
another  ovary  was  seen  ";  then,  three-quarters  of  an  inch 
further  along  the  ovarian  ligament,  the  "  outer  portion  of 
ovary  had  become  cystic."  This  was  removed,  the  healthy 
portion  remaining  untouched. 

Hence,  the  complete  removal  of  this  ovarian  tumour 
would  not  be  synonymous  with  the  complete  removal  of 
all  ovarian  tissue. 

Mr.  Alhan  Dor  an  ^  reports  a  reliable  case  of  accessory 
ovary.     He  says: 

"  In  one  ovarian  ligament  I  found  an  accessory  ovary,  a  condition 
which  may,  in  some  cases,  explain  the  persistence  of  menstruation 
and  the  possibility  of  normal  pregnancy  after  the  removal  of  both 
ovaries  in  operations  for  ovarian  tumours,  inflammatory  disorders 
of  the  appendages,  and  ectopic  gestation." 

That  it  was  a  true  additiofial  mass  of  ovarian  tissue  was 
proved  by  Dr.  Cuthhert  Lockyer,  who  examined  it  micro- 

^  Bland-Sutton,  "  Diseases  of  Ovaries,"  1896,  p.  25. 

2  Dr.  Galabin,  "  Trans.  Obstet.  Soc,"  vol.  xliii.,  1901,  pp.  268,  269. 

^  Alban  Doran,  "  Trans.  Obstet.  Soc,"  vol.  xlvii.,  1905,  p.  384. 


i 


CASES  THOUGHT  TO  DISPROVE  THEORY     163 

scopically.  Dr.  J.  W.  Ballantyne^  has  found  an  accessory 
ovary  which  had  ovulated  "  at  least  once,  for  a  cicatrix 
was  found." 

A  further  case  is  recorded  by  Dr.  W.  P.  M anion,  of 
Detroit,  in  the  "  St.  Louis  Medical  Review,"  January  1906. 
He  describes  the  case  as  a  third'  ovary,  which  was  found 
beneath  the  peritoneum  of  Douglas's  pouch: 

"  The  patient  was  a  woman  from  whom  one  ovary  had  been  re- 
moved and  the  other  one  resected.  The  third  ovary  was  about 
one  inch  long  and  three-quarters  of  an  inch  wide.  It  had  always 
been  very  sensitive  to  pressure,  and  apparently  gave  rise  to  back- 
ache. It  was  removed  on  the  occasion  of  a  second  operation,  and 
since  that  time  the  symptoms  have  been  relieved.  Microscopical 
examination  showed  that  the  structure  had  typical  ovarian  stroma, 
and  contained  a  few  degenerated  Graafian  follicles." 

It  is  very  doubtful  if  this  was  a  true  third  or  supernumerary 
ovary.  It  was  probably  an  additional  patch  of  ovarian 
tissue,  or  accessory  ovary. 

We  are  forced,  therefore,  to  believe  in  the  very  occasional 
presence  of  an  accessory  ovary,  quite  apart  from  fragments 
of  ovarian  tissue  which  may  be  left  behind,  either  in  the 
ovarian  ligament  or  elsewhere,  when  attempts  are  made  to 
remove  ovarian  tumours,  more  especially  in  those  found  to 
be  bound  down  by  adhesions.  And  this  supplies  another 
anatomical  reason  for  the  occasional  occurrence  of  the  birth 
of  a  child  after  unilateral  ovariotomy,  whose  sex  agrees  with 
the  ovary  thought  to  be  removed.  The  sceptic  may  claim 
that  the  child  came  from  the  untouched  ovary,  but  this 
fails  him  when  both  ovaries  have  been  removed ;  we  then  have 
direct  proof  that  all  ovarian  tissue  has  not  been  removed, 
because  ovulation  must  have  occurred  to  permit  of 
pregnancy. 

Another  reason  why  ovarian  tissue  may  be  left  behind, 
Sir  J.  Bland-Sutton^  says,  is: 

"  The  ovaries  may  be  so  firmly  fixed  to  the  floor  of  the  pelvis  that 
they  break,  and  portions  of  ovarian  tissue  are  left ;  this  often  impairs 
the  subsequent  results,  as  menstruation  (and  ovulation)  continue 
if  only  a  small  portion  of  an  ovary  is  left." 

^  Loc.  cit.,  p.  130. 

2  Bland-Sutton,  "  Diseases  of  Women,"  1904,  p.  485. 


i64  THE  CAUSATION  OF  SEX 

Dr.  Cullingworth^  reports  a  case  which  is  an  example  of 
this: 

"  The  much  enlarged  right  ovary  with  the  Fallopian  tube  .  .  . 
were  removed.  The  appendages  of  the  opposite  (left)  side  were  then 
separated;  during  the  process  rupture  of  the  (left)  ovary  took  place. 
The  (left)  tube  and  ovary  wer^  removed,  the  greater  part  of  the  ovary 
remaining  as  part  of  the  pedicle." 

On  examination  of  the  parts  removed — 

"  The  left  Fallopian  tube  was  beaded  from  kinking,  but  was  other- 
wise healthy.  No  ovarian  tissue  was  found  in  the  parts  removed 
on  the  left  side." 

So  that  the  removal  of  this  left  ovary  was  a  complete 
failure;  not  only  did  the  left  ovary  break,  but  the  "  greater 
part  of  it  remained  in  the  pedicle/'  and  not  even  a  portion 
of  the  left  ovarian  tissue  could  be  detected  as  having  been 
removed,  with  its  accompanying  left  tube,  and  this  in  spite 
of  the  statement  that  "  the  (left)  tube  and  ovary  were 
removed." 

The  patient  recovered  from  the  operation,  since  when 
**  menstruation  has  been  regular,"  because  of  the  incomplete 
removal  of  all  ovarian  tissue. 

Olshausen  (see  Chapter  X.,  p.  80)  performed  bilateral 
ovariotomy.  At  the  post-mortem  he  found  that  neither  ovary 
had  been  removed ! 

As  ovarian  tissue  can  be  left  behind  when  operating  on 
one  ovary,  so  too  it  can  occur  if  both  ovaries  are  removed; 
it  is  even  possible  that  a  piece  of  ovarian  tissue  might 
remain  on  both  sides,  so  that  boy  and  girl  twins  might  be 
born  after  double  or  bilateral  ovariotomy  !  though  I  know 
of  no  case. 

There  are  on  record  now  a  dozen  genuine  cases  of 
pregnancy  after  double  or  bilateral  ovariotomy ;  and  we 
could  not  realise  this  were  we  not  aware  of  the  extreme 
difficulty,  amounting  to  impossibility  in  some  cases,  of 
completely  removing  all  ovarian  tissue,  more  especially  if 
there  has  been  any  inflammatory  action  of,  or  around,  the 
ovarian  tumour.  And  Mr.  Alban  Dor  an' s  ^  experience  may 
here  be  quoted: 

1  Dr.  Cullingworth,  "  Trans.  Obstet.  Soc,"  vol.  xxxiv.,  1892,  pp.  388,  389. 

2  A.  Doran,  "  Trans.  Obstet.  Soc,"  vol.  xliv.,  1902,  p.  249; 


CASES  THOUGHT  TO  DISPROVE  THEORY     165 

"  When  the  base  of  the  cyst  burrowed  and  lay  close  against  the 
uterus  the  ovarian  ligament  could  rarely  be  distinguished.  In  one 
case,  where  Mr.  Doran  was  obliged  to  remove  the  uterus,  with  the 
burrowing  adherent  tumour,  he  found,  on  examining  the  specimen, 
that  it  would  have  been  practically  impossible  to  leave  the  round 
ligament  or  part  of  a  pedicle  without  leaving  also  ovarian  tissue,  morbid  or 
healthy.  As  it  was  with  a  cystic  tumour,  so  it  was  with  inflamed 
adherent  appendages,  and  so  it  very  often  was  with  an  ovary  re- 
moved to  check  the  growth  of  a  uterine  fibroid." 

The  following  cases  too,  quoted  by  Sir  J.  Bland-Sutton,^ 
show  the  excessive  difficulty  in  some  cases  of  entirely 
removing  both  ovaries: 

"  Dr.  Angus  Macdonald  attempted  bilateral  oophorectomy  on  a 
young  woman.  He  removed  the  left  ovary  and  tube,  but  failed 
to  find  the  right  one.     In  March  1886,  Mr.  Lawson  Tait  tried  to  find 


STUMP  OF  THE 
FALLOPIAN   TUBE 


SILK  LIGATURE 


CORPUS   LUTEUM 


Fig.  21. — Fragment  of  Ovary  containing  a  Corpus  Luteum  left 
after  a  supposed  complete  removal  of  both  ovaries,  etc. 
(Bland-Sutton.) 

the  right  ovary,  but  failed.  He  took  away  the  fundus  of  the  uterus. 
In  spite  of  this  menstruation  continued.  In  1890  Dr.  Keith  re- 
opened the  belly,  found  and  removed  the  right  ovary  and  its  corre- 
sponding portion  of  tube.  The  patient  recovered,  and  menstruation 
permanently  ceased." 

"  Mr.  Martin  removed  the  uterus  two  years  after  removing  both 
ovaries.     He  found  that  a  piece  of  ovary  had  been  left  behind." 

Dr.  Amand  Routh,^  too,  has  stated  "it  is  sometimes 
impossible  to  remove  both  ovaries  completely."^ 

Finesse  concludes  "  that  persistence  of  menstruation  after 
the  removal  of  both  ovaries  and  tubes  is  due  to  portions  of 

1  Bland-Sutton,  "  Diseases  of  Ovaries,"  i8g6,  p.  416. 

2  Dr.  A.  Routh,  "  Brit.  Med.  Journ.,"  October  1903,  p.  801. 


i66  THE  CAUSATION  OF  SEX 

ovarian  tissue  left  behind,"  and  states  that  "  in  second 
operations  corpora  lutea  were  seen  on  the  stumps  of  the 
pedicle  left  after  the  primary  operations." 

Sir  J.  Bland-Sutton^  has  the  drawing  on  p.  165  illustrating 
this  completely,  a  portion  of  ovary  with  a  corpus  luteum  in 
it  (evidence  of  ovulation)  being  shown.  It  was  found  at 
a  second  operation,  and  had  been  left  after  a  supposed 
complete  double  oophorectomy.     He  says: 

"  Such  a  retained  portion  of  ovary  is  sufficient  to  maintain  not 
only  menstruation,  but  ovulation,  and  it  will  form  corpora  lutea." 

Ovulation  is  the  function  of  the  ovaries;  hence  if  all 
ovarian  tissue  be  removed  ovulation  is  arrested,  the  woman 
is  absolutely  sterile,  and  menstruation  permanently  ceases. 

And  here  it  will  be  well  to  inquire  how  much — or,  rather, 
how  little — ovarian  tissue  will  be  sufficient  to  ovulate,  and 
thus  lead  to  the  birth  of  a  child. 

.  The  ova  being  microscopic,  we  should  expect  from  this 
that  an  exceedingly  small  portion  only  would  be  necessary, 
and  this  is  what  we  find  to  be  the  case. 

The  following  extracts  prove  it: 

Dr.  Galahin^  showed  tumours  of  both  ovaries  removed  at 
the  fourth  month  of  pregnancy. 

"  The  right  tumour  was  a  dermoid  cyst  Containing  gruel-like  fluid, 
which  solidified  on  cooling, 

"  The  left  tumour  was  an  ordinary  cystic  adenoma,  except  that 
three  small  cysts  in  it  were  evidently  dermoid.  In  the  left  tumour 
was  seen  a  large  corpus  luteum  of  pregnancy,  and  near  it  a  small 
fragment  of  unaltered  ovary." 

A  paper,  too,  by  Dr.  Condamin,^  of  Lyons,  on  pregnancy 
in  women  suffering  from  large  bilateral  ovarian  dermoids, 
shows  how  little  ovarian  tissue  is  requisite  to  give  rise  to 
a  fertilisable  ovum;  and  Dr.  Herman'^  says  that,  "  even  in 
bilateral  ovarian  disease,  so  advanced  that  healthy  ovarian 
tissue  cannot  be  detected  by  the  naked  eye,  the  patient 
may  become  pregnant." 

1  "  Diseases  of  Women,"  1904,  Fig.  126,  p.  495. 

2  Galabin,  "  Trans.  Obstet.  Soc,"  1896,  p.  loi. 

^  Condamin,  "  Annals  of  Obstetrics  and  Gynaecology,"  March  1904,  p.  18S. 
^  Herman,  "  Diseases  of  Women,"  p.  763. 


CASES  THOUGHT  TO  DISPROVE  THEORY     167 

Further,  Sir  J.  Bland-Sutton^  says: 

"  Both  ovaries  may  be  so  distorted  and  destroyed  by  dermoids  that 
the  true  ovarian  tissue  is  unrecognisable  to  the  naked  eye;  yet  these 
organs  are  not  only  able  to  dominate  menstruation,  but  to  discharge 
their  egg-bearing  functions  successfully." 

Again,  he  says,  in  a  case  where — 

"  Bantock  performed  double  ovariotomy  on  a  woman  in  the  third 
month  of  pregnancy,  both  tumours  were  dermoid.  He  made  a  very 
careful  microscopical  investigation  of  them,  but  was  unable  to  detect 
normal  ovarian  tissues." 

Yet  some  normal  tissue  had  provided  the  ovum  that  was 
fertihsed  in  both  Dr.  Bantock' s  and  Dr.  Galabin's  cases; 
so  we  see  what  an  infinitesimally  small  portion  of  ovarian 
tissue,  if  left  behind  at  an  operation,  or  undamaged  by 
tumour  growth,  is  capable  of  yielding  fertilisable  ova — in 
fact,  a  single  Graafian  follicle  is  enough  to  accomplish 
the  purpose. 

In  the  following  case  Lefas^  found: 

"  To  one  of  the  fimbriae  of  the  right  tube  was  attached  a  little  round 
tumour,  perfectly  separate  from  any  other  structure,  besides  the  fimbriae 
which  formed  its  pedicle.  Microscopically  it  was  a  true  corpus 
luteum." 

So  this  tiny  piece  of  ovarian  tissue,  quite  separate  from 
the  ovary,  attached  only  to  the  abdominal  end  of  the  tube, 
had  ovulated — so  that  pregnancy  might  have  followed  the 
removal  of  that  ovary. 

With  what  Morgagni  said,  "  a  woman  may  conceive  if 
there  remain  as  much  of  one  ovary,  sound,  as  belongs  to  one 
mature  vesicle,"  we  must  therefore  agree. 

Confirmatory  of  the  difficulty  of  affirming  that  no  ovarian 
tissue  had  been  left  behind,  are  the  remarks  by  Dr.  Eden  in 
the  discussion  of  a  case  at  the  Obstetrical  Society  of  London; 
March  2,  1904.     He  said: 

"  It  was  impossible  to  be  sure,  by  simple  inspection  at  the  time 
of  operation,  that  the  whole  of  the  ovary  or  ovarian  tissue  had  been 
removed.  Only  careful  microscopical  examination  by  serial  section 
of  every  small  mass,  elevation,  or  nodule — possible  only  after  a  post- 

^   Bland-Sutton,  "  Diseases  of  Ovaries,"  1896,  p.  61. 

2  "  Journal  of  Obstetrics  and  Gynaecology,"  vol.  i.,  Jan.  1902,  p.  109. 


i68  THE  CAUSATION  OF  SEX 

mortem — could  negative  the  existence  of  unremoved  ovarian  tissue 
lying  in  the  ovarian  pedicle  or  between  the  layers  of  the  broad 
ligament." 

Having  thus  seen  how  infinitely  small  the  piece  of  ovarian 
tissue  left  behind  may  be,  we  must  next  point  out  that  there 
are  reasons  to  believe  that  these  unremoved  portions  may 
grow,  in  much  the  same  manner  as  does  a  tonsil  stump  after 
the  removal  of  a  portion  of  the  tonsil. 

Belief  in  the  growth  and  development  of  these  portions 
of  ovary  and  their  contained  follicles  was  stated  by  Dr. 
Amand  Routh}    He  said: 

"He  thought  it  likely  that  a  small  piece  of  the  hilum  of  one  ovary 
might  be  left  containing  no  Graafian  follicles  sufficiently  developed 
to  come  immediately  to  maturity.  He  believed  that  such  a  piece 
of  ovarian  stroma,  together  with  the  follicles,  became  in  a  few  months 
further  developed,  and  ovulation  and  menstruation  then  recurred." 

There  are  some  specimens  in  the  Royal  College  of  Surgeons 
Museum  showing  the  results  of  incomplete  castration  in 
cockerels,  and  they  seem  to  strengthen  the  belief  that 
portions  of,  unremoved  ovarian  tissue  may  grow,  for  the 
glands  in  cockerels,  if  only  partially  removed,  are  repro- 
duced, and  the  birds  acquire  the  full  male  characters. 

As  a  result  of  the  appreciation  of  the  fact  that  a  portion 
of  ovary  is  sufficient  to  ovulate,  the  operation  of  resection 
of  an  ovary  has  been  introduced.  This  consists  in  cutting 
out  the  tumour  or  diseased  part,  and  leaving  the  healthy 
remainder.  This  has  been  often  done  now,  and  with  the 
best  results,  pregnancy  having  followed  such  an  operation. 

Besides  pregnancy  following  as  the  result  of  ovarian  tissue 
being  left  behind,  either  accidentally  or  intentionally  as  a 
result  of  resection  of  an  ovary,  we  can  also  have  tumours 
arise  in  the  unremoved  pieces. 

Thus  Dr.  Herbert  Spencer,'^  when  discussing  a  case  of 
pregnancy  after  incomplete  bilateral  ovariotomy,  said  he 
thought — 

"  that  some  portion  of  one  of  the  tumours  had  probably  been  left 
behind  in  separating  the  adhesions.  He  had  known  an  ovarian 
tumour  develop  after  double  ovariotomy  from  this  cause." 

^  Dr.  A.  Routh,  "  Trans.  Obstet.  Soc,"  vol.  xliv.  1902,  p.  248. 

2  Dr.  H.  R.  Spencer,  "  Trans.  Obstet.  Soc,"  vol.  xliv.  1902,  p.  247. 


CASES  THOUGHT  TO  DISPROVE  THEORY     169 

This  leaving  a  portion  of  ovarian  tissue,  due  to  adhesions 
round  a  tumour,  is  evidently  what  had  happened  to  Dr. 
Spencer  when,  in  vol.  xlii.,  p.  396,  he  announced  the  birth 
of  boy  and  girl  twins  after  he  had  "  removed  a  left-sided 
ovarian  tumour  completely  ";  but  which  he  also  stated  was 
"  bound  down  by  adhesions,"  when  he  described  the  case. 
So  that  case  does  not  negative  my  theory. 

Other  operators  have  noted  tumours  arising  in  ovarian 
remnants.  Thus  Mr.  Alhan  Dor  an  has  seen  "  an  ovarian 
cyst  develop  on  the  distal  side  of  a  ligatured  stump." 

Mr.  J.  D.  Malcolm^  in  the  "  Lancet,"  reported  four  cases: 
in  three  bilateral  ovariotomy  had  been  performed,  and  a 
tumour  grew  on  one  or  other  side;  in  the  other  case  the 
tumour  recurred  on  the  side  the  ovarian  tumour  was  re- 
moved from.     Mr.  Malcolm  stated  that — 

"  some  portion  of  the  ovary  had  been  left,  and  it  was  most  interest- 
ing and  important  to  know  that  a  small  piece  of  an  ovary  remaining 
in  this  way  could  give  rise  to  an  ovarian  tumour." 

We  therefore  see  that  complete  removal  of  an  ovarian 
tumour  is  not  synonymous  with  the  complete  removal  of  all 
ovarian  tissue,  and  my  theory  remains  quite  unshaken. 

Although  I  have  thus  clearly  shown  that  {a)  portions  of 
ovarian  tissue  may  be  left  behind  after  operations;  and 
further  that  {h)  ovarian  tissue  in  small  detached  pieces 
may  occur  some  distance  from  the  operation  site,  yet  the 
general  rule  holds  good  that — the  removal  of  the  anatomical 
ovary  on  one  side  removes  all  the  ovarian  tissue  from  that 
side. 

And  the  result  is  the  birth  of  only  one-sexed  children 
after  such  an  operation. 

The  two  or  three  cases  brought  forward  to  the  contrary 
disprove  not  my  theory,  for  in  these  few  exceptional  cases 
who  shall  say  some  true  ovarian  tissue  had  not  been  left 
behind  ?  or  that  there  was  no  accessory  ovarian  tissue  ? 

1  J.  D.  Malcolm,  "Lancet,"  Oct.  31,  1903;  "Trans.  Obstet.  Soc," 
1893.  P-  37- 


CHAPTER  XXII 
THE  ALTERNATE  ACTION  OF  THE  OVARIES 

We  have  seen  that  ovulation  is  a  spontaneous,  usually 
painless,  unilateral  process,  and,  I  maintain,  an  alternate 
one.^ 

To  prove  that  ovulation  takes  place  practically  alternately 
from  the  two  ovaries,  besides  referring  the  reader  to 
Chap.  VI.,  p.  49,  where  I  quote  Negrier  and  give  other 
proofs,  the  following  facts  should  be  conclusive: 

From  Chap.  XL,  p.  82,  we  learnt  that  each  half  of  a  double 
uterus  has  only  one  ovary  attached  thereto,  so  that  we  can 
be  sure  in  such  cases  that  one  ovary  only  is  associated  with 
the  menstruation  from  one-half  of  the  uterus ;  for  the  two 
ovaries  do  not  normally  ovulate  at  the  same  time,  neither 
do  the  two  halves  of  a  double  uterus  menstruate  synchron- 
ously. 

Negrier  showed  that,  if  both  halves  of  a  double  uterus 
are  fully  developed,  menstruation  (the  outward  sign  of 
ovulation)  occurred  from  each  half  every  alternate  month — 
i.e.  ovulation  occurred  alternately.  Engel^  narrated  a 
case  of  double  uterus,  where  the  "  two  halves  of  the  uterus 

^  This  contention  of  alternate  ovulation,  as  well  as  the  whole  theory 
generally,  has  been  condemned  by  a  very  well-known  consultant  as  "  too 
mechanical."  This  seems  a  very  inconsistent  objection  when  we  recall 
how  essentially  mechanical  the  whole  of  life  is.  Is  not  our  very  respiration 
mechanical  in  its  regularity  ?  So,  too,  is  our  heart's  action,  and  why 
the  latter  should  be  the  more  rapid  of  the  two  we  know  not,  neither  can  we 
alter  their  respective  rhythms.  Disease,  such  as  pneumonia,  does  so;  but 
this  is  abnormal  rhjrthm,  and  recovery  soon  leads  to  a  return  to  the  normal. 
Menstruation,  too,  has  a  mechanical  regularity  in  its  recurrence,  which 
in  many  cases  is  quite  marvellous,  for  most  women  can  tell  to  a  day,  while 
some  women  to  my  own  knowledge  can  tell  to  an  hour  almost,  when  their 
period  is  due. 

Seeing,  therefore,  the  essentially  mechanical  nature  of  the  three  im- 
portant functions  of  respiration,  circulation,  and  menstruation,  we  can 
hardly  look  upon  this  as  a  valid  objection  to  the  theory. 

2  Engel,  quoted  by  Dr.  A.  Giles,  "  Trans.  Obstet.  Soc,"  1S95,  vol.  xxxvii., 
P-  333- 

170 


THE  ALTERNATE  ACTION  OF  THE  OVARIES     171 

menstruated  separately";  while  Jurinka,^  quoted  by 
Dr.  C.  Lockyer,  writing  on  menstruation  in  double  uterus, 
says:  "  Such  uteri  are  functionally  normal,  the  two  halves 
alternating  in  the  menstrual  process." 

Hence,  as  menstruation  thus  occurs  alternately  from  the 
uterine  halves,  so  also  must  the  ovulations  be  alternate 
from  the  ovary  attached  to  each  half  of  the  uterus,  and  thus 
alternate  menstruation  is  indicative  of  alternate  ovulation. 

Now,  if  the  two  halves  have  coalesced  (as  is  normal) 
to  form  the  single  cavity  uterus,  the  respective  ovaries 
will  certainly  alternately  ovulate,  and  menstruation  will 
now  necessarily  appear  regularly  each  month  from  the  single 
uterine  cavity. 

In  the  following  case  Ballantyne^  quotes  T.  A.  Emmet 
as  recording  a  case  of  double  uterus  with  one  half  imper- 
forate: "There  was  a  bimonthly  menstrual  flow  from  one 
half,  while  on  the  other  side  there  is  an  imperforate  condition 
of  the  horn,"  so  that  the  ovary  attached  to  the  normal 
side  ovulated  every  second  month,  as  evidenced  by  the  bi- 
monthly menstruation;  for,  as  Strassmann  says:  "Each 
menstruation  is  the  expression  of  an  ovulation." 

The  nearly  equal  birth-rate  of  boys  and  girls — viz.  106  to 
100 — proves  that  nearly  an  equal  number  of  ova  are  pro- 
vided by  the  two  ovaries,  so  this  further  corroborates 
alternate  ovulation,  because  we  have  seen  that  the  two 
ovaries  do  not  act  at  the  same  time.  Bilateral  ovulation 
is  not  normal,  so  they  must  act  nearly  alternately  to  insure 
a  nearly  equal  number  of  children. 

1  have  details  of  several  cases  of  alternate  good  and  bad 
menstrual  periods. 

Thus  Miss  U.  M.,  age  twenty-eight,  for  the  last  seven 
years  at  least  has  noticed  that  she  has  "  alternately  bad 
{i.e.  painful)  periods,  followed  by  a  good  or  painless  one." 

When  she  has  a  bad  period  she  has  "  great  "  pains  run- 
ning down  from  the  right  iliac  spine  and  down  the  right 
groin.  The  next  period  (the  good  or  not  markedly  painful 
one)  she  "  does  not  notice  any  of  these  right  inguinal  pains, 
though  she  has  slight  pain  over  the  lower  abdomen." 

^  Jiirinka,  "  Journ.  of  Obstet.  and  Gyn.,"  vol.  v.,  1904,  p,  174. 

2  Ballantyne  in  Allbutt,  Playfair  and  Eden's  "  System  of  Gynaecology," 
1906,  p.__i42. 


172  THE  CAUSATION  OF  SEX 

This  case  points  to  ovulation  (which  is  admitted  to  occur 
at  or  about  a  menstrual  period,  and  to  have  its  "  external 
sign  in  menstruation  ")  being  one  month  painless,  but  next 
month  painful;  and  the  pain  being  always  over  the  right 
ovary  points  to  the  right  ovary  ovulating  with  pain  one 
month,  and  the  left  ovary  ovulating  painlessly  the  month 
following. 

As  the  pain  shows  an  alternate  monthly  periodicity,  we 
must  conclude  that  the  right  ovary  ovulates  every  alternate 
month. 

Miss  M.  S.,  age  twenty-seven.  **  Has  a  good  period, 
then  a  bad  one;  then  the  next  will  be  another  good  one." 
"  The  pain  is  always  on  the  right  side  at  the  bad  periods, 
never  on  the  left." 

She  does  not  get  two  good  periods  running,  so  that  we 
have  bimonthly  painful  ovulation,  with  the  pain  always 
on  the  same  side,  the  right. 

Miss  W.  menstruates  every  thirty  days.  She  has  pain 
over  the  right  ovarian  region  and  down  the  right  leg  every 
second  period.  It  is  quite  marked  and  different  from  the 
slight  abdominal  discomfort  of  the  other  times.  These 
cases  point  to  painful  ovulation  from  the  right  ovary  each 
alternate  month,  that  from  the  left  ovary  being  practically 
painless. 

Mrs.  J.  J.  has  alternately  painful  periods.  She  has 
considerable'  pain  in  the  left  ovarian  region  every  other 
month;  the  "  other  periods  she  is  unaware  of,  except  for 
the  show."     She  has  no  pains  then. 

Miss  T.  T.'s  periods  are  very  regular,  every  twenty-eight 
days.  There  is  always  some  pain,  but  every  other  period 
is  a  bad  one,  and  she  notices  the  pain  is  always  worst  over 
the  left  ovarian  region  at  these  bad  alternate  periods. 
She  then  has  to  keep  her  bed,  and  is  often  bad  and  unable 
to  do  her  work  for  over  a  week.  Her  mother  often  says, 
"  Never  mind;  you'll  have  a  better  time  next  time."  At 
the  good  times  the  pain  is  slight  and  diffused  over  the 
abdomen;  "  at  the  bad  times  it  is  most  severe,  and  is  always 
most  marked  over  the  left  ovarian  region." 

In  these  cases  we  have  bimonthly  excessive  pains,  always 
over  the  left  ovary;  at  the  other  times  it  is  diffused  over  the 


THE  ALTERNATE  ACTION  OF  THE  OVARIES     173 

abdomen,  and  is  only  slight,  pointing  to  markedly  painful 
and  incapacitating  left-sided  ovulation  every  second  month. 

Mrs.  G.  H.  since  the  age  of  twenty-one  has  had  alternately 
good  and  bad  periods.  During  the  bad  periods  the  pain 
is  always  on  the  left  side,  over  the  ovarian  region,  never  on 
the  right  side,  and  for  the  first  day  it  quite  incapacitates  her. 

Miss  E.  G.,  twenty,  has  alternately  good  and  bad  periods. 
At  the  bad  periods  the  pain  is  always  over  the  left  ovarian 
region,  and  is  so  bad  as  to  make  her  limp  and  feel  faint. 
She  has  "  no  pain  at  all  during  the  good  period  "  beyond 
the  aching  of  the  legs,  which  she  has  during  all  her  periods. 

Miss  F.  D.,  eighteen,  has  one  good  period  as  regards 
pain,  but  the  next  is  a  bad  one,  though  the  amount  lost 
each  period  is  the  same.  The  pain  is  always  over  the  left 
ovarian  region,  never  on  the  right  side.  "  Some  of  the  good 
periods  there  is  actually  no  pain  at  all,"  but  at  "  the  next 
period  there  would  be  great  pain,  and  always  on  the  left 
side." 

Again,  Miss  H.  C,  age  twenty-six.  The  periods  used  to 
be  "  nearly  painless." 

The  last  eighteen  months  she  has  had  pains  in  the  left 
hip  and  dragging  pains  in  the  left  iliac  region.  For  the  last 
two  years  the  menstrual  periods  have  been  alternately 
easy,  and  the  next  very  painful. 

"  The  easy  periods  are  like  those  she  used  to  have  at  first.  In  the 
painful  ones  the  pain  is  always  in  the  left  groin;  the  easy  and  painful 
periods  are  quite  alternate." 

Here  the  pain  recurring  every  other  month  over  the  left 
ovary  points  to  the  fact  that  the  left  ovary  ovulates  every 
other  month  with  pain,  while  the  right  ovulation  is  painless. 

Mrs.  D.  F.  says:  "  Every  other  month  I  have  a  flooding. 
The  period  one  month  is  fairly  quiet,  but  the  next  one  is 
a  flooding,"  and  so  on  alternately.  She  "  cannot  go  out 
for  first  three  days  of  her  bad  periods." 

Alternately  profuse  and  normal  periods. 

Miss  L.  S.  says:  "  Every  second  month  I  am  bad.  One 
month  I  am  up  and  as  well  as  can  be;  next  month  I  am 
awfully  poorly  and  in  bed  the  first  day." 

Alternate  painful  and  painless  ovulation. 


174  THE  CAUSATION  OF  SEX 

Miss  S.  S.  T.  has  alternately  good  and  bad  periods, 
though  the  pain  is  not  definitely  confined  to  one  side. 

Miss  F.  Y.,  twenty- two,  has  alternate  profuse  and  scanty 
periods.  Uses  double  the  number  of  squares  at  her  bad 
period  to  what  she  does  at  the  next  or  slight  one.  She  has 
no  abdominal  or  ovarian  pains. 

.  In  the  following  case  a  married  patient  has  a  left  inguinal 
hernia,  whose  sac  probably  contains  the  left  ovary;  it  is 
not  a  true  hernia  of  the  ovary. 

Mrs.  H.  L.  has  had  two  boys  and  no  girls  ! 

She  wears  a  truss  for  a  left  inguinal  hernia,  which  is 
painful  at  alternate  periods.  When  wearing  it  she  has  no 
pain  in  the  lump  "  except  when  she  is  poorly."  She  then 
has  to  take  off  the  truss  "  to  ease  the  pain  in  the  lump." 

"  I  don't  have  the  two  months  aUke;  one  month  the  pain  is  worse 

than  the  next." 

"  The  lump  is  tender  to  the  touch  when  poorly." 

"  The  pain  makes  me  feel  quite  sick;  it  is  worse  one  month  than 

another." 

The  left  ovary  is  probably  in  the  hernial  sac. 

Note,  too,  that  both  her  children  came  from  the  right, 
or  normal  ovary,  and  so  were  boys. 

The  alternate  monthly  pain  over  the  left  ovary  points 
to  the  left  ovary  ovulating  every  other  month  with  pain, 
the  right  ovulation  being  painless. 

Mrs.  F.  P.  menstruates  every  second  month  only,  and 
then  without  pain.  At  the  time  when  the  next  period 
should  appear,  but  does  not,  she  has  great  pain  over  the 
right  ovarian  region,  never  over  the  left.  This  pain  occurs 
bimonthly.  So  one  month  there  is  painless  menstruation; 
next  month  pains,  always  over  the  right  ovarian  region, 
but  no  menstruation  appears. 

She  has  had  two  children — both  girls  ! 

First,  then,  this  case  should  be  compared  with  the  previous 
one,  and  the  difference  in  the  children  noted.  This  case 
shows  bimonthly  normal  ovulation  from  the  left  ovary, 
and  painless  menstruation,  followed  next  month  by  distinct 
pains  over  the  right  ovary,  but  no  external  evidence  by 
menstruation  of  ovulation  taking  place.  We  must  infer 
normal  ovulation  from  the  left  ovary,  and  abnormal  from 


THE  ALTERNATE  ACTION  OF  THE  OVARIES     175 

the  right  ovary,  and  amenorrhoea.  Practical  proof  is  shown, 
by  the  two  children  being  of  the  same  sex  (female),  that 
the  ova  came  from  the  left  ovary;  it  is  therefore  a  most 
convincing  case. 

In  this  case,  a  patient  of  Dr.  T.  G.'s  had  a  severe 
attack  of  appendicitis,  and  later  a  large  appendix  abscess 
formed.  Since  then  she  has  had  more  pain  in  the  right 
ovarian  region,  with  each  alternate  menstruation,  than 
formerly,  and  she  has  since  had  two  girls,  but  no  boy  ! 

Here,  probably,  owing  to  inflammatory  adhesions,  etc., 
round  the  appendix,  and  consequently  in  the  near  neigh- 
bourhood of  her  right  ovary,  the  latter  has  become  bound 
down,  and  hence  ovulation  therefrom  has  become  painful; 
and  quite  possibly  the  ova  are  unable  to  properly  escape, 
and  so  reach  the  Fallopian  tube.  So  that  both  her  children 
have  been  girls,  as  no  ovum  from  the  right  ovary  has  been 
available. 

I  think  I  may  rightly  claim  that  these  cases  prove  alternate 
monthly  painless  and  painful  ovulation  evidenced  by 
alternate  monthly  pain  over  one  and  always  the  same  ovary. 

It  must  be  recalled  that  Garrigues  ^  states  that — 

"  In  some  patients  I  have  observed  that  alternately  one  or  the  other 
ovary  undergoes  a  considerable  swelling  at  the  time  of  every  men- 
struation." 

So  that  this  corroborates  the  alternate  ovulation  of  the 
ovaries. 

Finally,  the  strongest  proof  of  alternate  ovulation  by  the 
ovaries  lies  in  practically  trying  it,  as  was  done  in  the  follow- 
ing case,  of  which  I  have  full  details.  It  is  most  convincing 
and  conclusive. 

Mrs.  T.  A.  G.  writes  thus  in  a  letter  to  me:  "  Having  pur- 
chased and  read  *  The  Causation  of  Sex,'  I  was  very  much 
struck  by  your  theory,  and  decided  to  put  same  to  the  test," 
so  "  we  commenced  to  make  notes  of  the  menstrual  periods." 
Then  follows  in  the  letter  a  list  of  menstrual  periods,  show- 
ing alternately  painful  and  painless  periods.  To  quote 
again:  "  You  will  see  by  above  that  we  were  able  to  tell 
which  side  ovulation  had  taken  place,  on  account  of  more 

^  Garrigues,  "  Diseases  of  Women,"  1900,  p.  122. 


176  THE  CAUSATION  OF  SEX 

or  less  pain  every  other  month  on  the  right  side."  "  In 
April  1914  we  decided  to  undertake  parenthood;  therefore 
you  will  see  that  we  expected  and  wanted  a  son.  April  14, 
1914,  was  the  last  period,  and  I  am  pleased  to  say  a 
son  (a  perfect  bonny  boy)  was  born  to  us  on  January  8, 1915." 

This  case  would,  I  presume,  be  called  a  "  chance  success  " 
by  one  of  my  sceptical  reviewers. 

Besides  these  cases  of  pain  every  alternate  month  over 
the  same  ovarian  region,  we  must  note  the  frequency  of 
unilateral  mammary  pain  in  association  with  menstruation. 

Pa.n  in  one  breast  only  during  menstruation  (the  out- 
ward sign  of  ovulation)  evidently  points  to  unilateral  and 
alternate  ovulation,  for  the  very  intimate  association  of 
the  breasts  and  the  genitalia  is  universally  known.  Dr, 
E.  J.  Tilt^  writes  of  "  the  intimate  sympathetic  connection 
existing  between  the  ovaries  and  the  breasts."  Temesvary,^ 
who  has  carefully  studied  the  subject,  has  noted  that  in 
some  cases  menstruation  causes  extremely  severe  mammary 
pain,  "  so  that  the  women  in  question  cannot  lie  on  the 
corresponding  side." 

As  the  breasts  are  usually  affected  alternately,  we  get 
proof  of  alternate  ovulation.  In  some  cases  one  breast 
only  is  painful  every  alternate  month,  so  we  are  justified 
in  saying  that  if  the  right  breast  is  painful,  then  the  right 
ovary  has  ovulated.  / 

The  following  is  an  actual  example  of  this  from  my  own 
practice : 

Mrs.  A.  C,  age  twenty-six,  has  neither  abdominal  nor 
ovarian  pains  at  her  periods,  nor  in  her  left  breast ;  but  she 
has  "  very  sharp  pains,  every  other  period,  in  the  right 
breast,  which  last  throughout  the  period."  She  cannot 
lie  on  her  right  side  during  these  alternately  painful  periods 
owing  to  the  pains  in  the  right  breast. 

That  only  one  breast  should  be  painful  every  other  month 
during  the  menstrual  period,  if  it  does  not  signify  ovulation 
from  the  corresponding  ovary,  would  be  hard  indeed  to 
explain.  It  certainly  supports  the  contention  of  alternate 
ovulation. 

^  E.  J.  Tilt,  "  Diseases  of  Women,"  2nd  edit. 

2  Temesvary,  "  Journal  of  Obstetrics  and  Gynaecology,"  vol.  iii.  1903, 
p.  513. 


THE  ALTERNATE  ACTION  OF  THE  OVARIES    177 

I  have,  too,  decisive  evidence  of  some  women  definitely 
noticing  "  shooting  '*  or  "  fine  pricking  sensations,"  Uke 
nerve  thrills  or  telegraphic  messages,  in  first  one  breast  only, 
then  next  month  in  the  other  breast  only,  for  from  three  to 
seven  days  prior  to  the  appearance  of  each  menstrual  period. 
This  points  not  only  to  ovulation  preceding  menstruation 
as  to  time,  but  also  being  usually  quite  painless  as  far  as 
the  ovary  or  ovarian  region  is  concerned.  Owing,  however,  to 
its  "  intimate  connection  "  with  the  breast,  a  nerve  message 
from  the  ovary  of  ovulation  having  occurred  therefrom  is 
conveyed  to  the  corresponding  breast  some  days  before  the 
flow  appears. 

As  the  patients  have  noticed  this  "  tingHng  "  message 
in  one  breast  one  month,  and  in  the  opposite  breast  the 
next  month,  we  have  here  most  conclusive  support  of 
alternate  ovulation.  It  is  to  be  noted  that  this  "  tingling  or 
pricking  sensation,"  indicative  of  ovulation,  is  quite  different 
from  the  lasting  mammary  pain  just  previously  described. 

Legiien  ^  reported  a  case  proving  the  intimate  association 
of  the  ovary  with  the  breast  of  the  corresponding  side.  He 
performed  ovariotomy  for  a  tumour  in  the  right  ovary. 

"  The  right  breast  at  once  underwent  atrophy." 

Dr.  T.  G.  Drennan^  has  noticed  cases  of  alternate  right 
and  left  mammary  pain,  and  deduces  alternate  ovulation 
therefrom. 

Whether  in  a  pregnant  woman  the  first  breast  to  have 
any  fluid  or  milk  corresponds  always  to  the  ovary  which 
has  supplied  the  fertilised  ovum — i.e.  whether  the  left  breast 
always  secretes  first  when  the  child  is  female,  and  vice  versa 
— is  a  very  difficult  question  to  prove. 

It  is  necessary  to  observe  only  primiparous  women,  for 
milk  very  early  and  easily  appears  in  the  breasts  of  multi- 
parae.  In  primiparae  I  find  that  milk  is  usually  present 
before  they  inform  their  doctor  they  are  pregnant  even; 
but  in  five  cases  I  have  proved  that  the  right  breast  had  milk 
in  it  first,  and  the  child  born  was  a  boy  in  each  case. 
Strangely  enough,  I  have  met  with  only  one  case  of  the  left 
breast  having  milk  first,  and  the  child  being  a  girl. 


1  "  Brit.  Med.  Journ.,"  Feb.  1904,  p.  388. 

^  "  American  Journal  of  Obstetrics,"  Oct.  1902,  p.  502. 


12 


178  THE  CAUSATION  OF  SEX 

In  the  case  of  Mrs.  E.  F.,  who  was  dehvered  by  me 
of  a  boy,  not  only  was  her  right  breast  much  larger  than 
her  left,  but  the  nipple  and  the  areola  were  most  marked, 
and  were  quite  six  times  larger  and  much  darker  than 
the  left  nipple  and  areola.  While  Mrs.  W.  H.,  who  was 
prematurely  delivered  of  a  stillborn  female  child  in  March 
1 91 1,  still  had  milky  fluid  oozing  from  her  left  nipple  on 
August  I,  191 1,  when  I  examined  her.  The  right  breast 
was  quite  dry,  and  she  had  never  seen  anything  there- 
from. 

Mrs.  L.  S.  G.  engaged  me  to  attend  her  on  June  20,  1912. 
She  was  turned  two  months  pregnant.  Her  right  breast 
was  so  much  larger  and  firmer  than  the  left  that  I  there  and 
then  predicted  a  boy  for  her.  I  delivered  her  of  a  boy  on 
January  15,  1913. 

I  have  been  unable  to  obtain  more  cases  owing  chiefly 
to  the  reserve  of  the  early  pregnant  woman,  and  her  not 
coming  under  observation  soon  enough. 

Confirmatory  of  this,  Sir  J.  Bland-Sutton^  and  Dr.  Lewers^ 
have  both  recorded  cases  of  milk  in  one  breast  only  in  cases 
of  tubal  pregnancy.  In  each  case  the  breast  corresponded 
in  its  side  to  the  gravid  tube,  and  therefore  to  the  oosperm- 
supplying  ovary.  Dr.  Lewers'  case  was  on  the  right  side; 
Sir  J.  Bland-Sutton  does  not  specify  which  side. 

I  have  seen  several  cases  of  abscess  in  the  breast  which 
corresponded  to  the  sex  of  the  child:  thus,  child  born 
female,  breast  affected  the  left,  and  vice  versa.  Billroth 
states  that  abscess  of  the  right  breast  is  distinctly  more 
frequent  than  abscess  of  the  left  breast,  there  being  250 
cases  of  abscess  in  the  right  breast  to  190  cases  of  left-breast 
abscess.  But,  then,  boys  are  more  often  born  than  girls, 
and  thus  probably  we  get  the  reason  for  the  greater  number 
of  right-breast  cases.  At  all  events,  the  breast  most  often 
affected  corresponds  with  the  ovary  which,  being  larger, 
leads  to  most  children  (males)  being  born.  Be  it  noted 
that  bilateral  mammary  abscess  is  distinctly  rare — about 
8  per  cent,  of  all  cases  only — and  boy  and  girl  twins  are  also 
rarer  than  single  boys  and  girls. 

1  "  Diseases  of  Ovaries,"  1896,  p.  296. 

-  "  Trans.  Obstet.  Soc,"  1900,  vol.  xlii.  p.  326. 


THE  ALTERNATE  ACTION  OF  THE  OVARIES    179 

These  cases,  then,  all  go  to  prove  alternate  action  of  the 
ovaries  in  ovulating,  for  we  have  had — 

pain  over  the  same  ovary  in  alternate  monthly  menstrual 
periods  ; 

pain  in  the  same  breast  in  alternate  monthly  menstrual 
periods ; 
and  the  intimate  association  of  the  breast  and  ovary  of  the 
same  side  are  proved  by 

milk  first  appearing  in  the  breast  corresponding  to  the 
side  of  the  pregnancy  (normal  or  extra-uterine) ; 

abscess  in  the  breast  corresponding  to  the  sex  of  the 
pregnancy. 
While  EmmeU's  case  of  bimonthly  menstruation  from  the 
normal  half  of  a  bicomute  uterus  is  convincing. 

If  fertilisation  invariably  followed  ovulation,  we  might 
expect  the  children  would  be  more  often  born  alternately 
male  and  female.  That  this  does  occur  sometimes  we  have 
seen  in  Chap.  XVII. 

Owing,  however,  to  the  uncertainty  of  fertilisation  in  the 
human  species,  and  to  the  fact  of  insemination  occurring 
at  any  time,  and  so  not  happening  to  fertilise  the  ovum  from 
the  opposite  ovary,  such  regular  alternation  in  the  sexes 
does  not  often  happen. 

It  is  otherwise,  however,  in  the  monotocous  animals, 
who  permit  insemination  (from  which  fertilisation  practically 
always  follows)  only  when  an  ovum  is  provided — i.e.  when 
on  heat — (see  Chap.  XIV.,  p.  99,  for  the  remarks  by  Farre) 
which  Heape  ^  -thus  confirms : 

"  In  many,  possibly  most  of  the  lower  mammals,  though  not  in  all 
of  them,  ovulation  and  heat  are  indissolubly  connected." 

In  mares  and  cows  especially  we  find  that  male  and  female 
offspring  appear  alternately,  provided  the  female  is  allowed 
access  to  the  male  when  instinct  or  "  nature  "  prompts 
her — that  is  to  say,  if  the  female  is  covered  when  the  mother 
first  ovulates  and  shows  sexual  desire — i.e.  the  first  rutting 
after  the  birth  of  her  recently  born  foal  or  calf. 

This  fact  is  well  known  to  many  veterinary  surgeons  in 
the  country.     A  friend  of  mine,  a  doctor,  "  by  acting  on 

^  Heape,  "  Trans.  Obstet.  Soc,"  1898,  p.  171. 


i8o  THE  CAUSATION  OF  SEX 

this  has  made  his  cow  give  him  three  heifers  (or  females) 
in  succession  by  preventing  the  bull  getting  at  her  for  a 
month  after  calving,  thus  missing  the  first  rut  or  ovulation, 
which  would  give  a  male." 

The  following  extract  from  a  private  letter  from  a  farmer 
correspondent  is  very  confirmatory : 

"  Our  experience  supports  your  theory  so  far  as  practice  goes. 
For  some  years  between  1888  and  1893  my  father  and  I  carried  out 
your  theory  in  breeding  our  pedigree  Jersey  herd.  We  concluded 
that  the  sex  changed  with  every  heat.  On  this  theory,  and  desiring 
cow  calves,  we  were  very  successful." 

The  fact  is  made  use  of  also  by  stockbreeders — e.g.  in 
South  Africa,  where,  when  "  ordering  cows  from  England 
to  calve  there,  they  stipulate  for  a  bull  calf  to  be  born, 
relying  on  its  being  so  if  the  last  calf  was  a  heifer." 

Dr.  L.  M.  Snow^  recently  thus  confirmed  this: 

"  Suppose  a  mare  has  a  filly  foal,  and  goes  to  the  horse  on  the 
ninth  day  after  foaling  and  becomes  pregnant,  the  foal  will  be  a  colt, 
for  at  her  last  rutting  time  she  became  pregnant  with  the  recently 
born  filly.  I  may  say  he  has  correctly  foretold  me  the  sexes  of  his 
foals  for  the  last  five  years." 

Because  a  woman's  children  are  not  alternately  male 
and  female  it  is  no  proof  that  ovulation  was  not  alternately 
from  the  right  or  male  and  left  or  female  ovary ;  it  signifies 
only  that  fertilisation  did  not  happen  to  occur  in  an  ovum 
from  the  opposite  ovary  to  the  one  which  yielded  the 
former  child. 

When  one  ovary  has  been  completely  removed,  ovulation 
from  the  remaining  ovary  soon  ceases  to  be  only  every 
alternate  month ;  a  compensatory  activity  sets  in,  and  both 
menstruation  and  ovulation  then  occur  every  month  with 
great  regularity,  as  usual.  We  all  know  how  vision,  hear- 
ing, and  manual  dexterity  become  keener  and  greater  when 
the  fellow  eye,  ear,  or  hand  become  useless  or  are  removed. 
In  the  same  manner  the  single  ovary  becomes  equal  to  all 
demands  upon  it ;  for  it  grows  and  increases  in  size  to  make 
up  for  the  deficiency,  rising,  as  it  were,  to  the  occasion 
and  fulfilling  the  function  of  the  two,  somewhat  like  the 
single  kidney  does  after  the  removal  of  its  fellow. 

^  "  Brit.  Med.  Journ.,"  May  16,  1903. 


CHAPTER  XXIII 

THE  FORECASTING   OR   PREDICTION   OF  THE 
SEX  OF  THE  COMING  CHILD 

From  the  contention  of  ovulation  occurring  alternately 
from  the  male  or  right  ovary,  and  the  female  or  left  ovary, 
I  have  been  able  to  correctly  forecast  the  sex  of  the  forth- 
coming child  of  my  pregnant  patients,  as  well  as  of  some 
others  whom  I  had  not  even  seen. 

I  claim  to  have  had  97  per  cent,  of  successes;  the  3  per 
cent,  of  failures  are  chiefly  due  to — inability  of  the  mother 
to  correctly  state  in  which  month  her  confinement  is  to  be 
expected.  Thus,  if  a  patient  states  she  is  to  be  confined 
in  June,  for  example,  and  I  have  predicted  a  female  child, 
but  she  is  delivered  of  a  full-time  male  child  in  May  or 
July,  my  prophecy  is  thrown  wrong;  but  she  would  have  been 
told  to  expect  a  male  in  either  of  those  months  had  the 
mother  said  she  expected  in  one  or  other  of  them.  Some 
of  these  cases  are  due  to  menstruation  occurring  once  at 
least  after  the  patient  has  become  pregnant,  so  that  the 
expected  month  of  birth  is  wrong.  Similarly,  should 
pregnancy  occur  during  lactation,  when  menstruation  is 
usually  absent,  it  would  be  difficult  to  know  exactly  which 
ovulation  had  been  fertilised. 

Forecasts  of  a  child's  sex  must  be  made  for  full-time 
children,  for  premature  children  may  or  may  not  make  the 
prediction  wrong,  since  if  born  two  months  too  soon  the 
sex  would  be  correctly  foretold  because  it  would  be  the  same 
as  in  the  full- term  month;  if  born  a  few  days  to  a  month 
too  soon  the  forecast  will  be  wrong. 

Such  immature  children  and  all  abortions  and  miscarriages 

181 


i82  THE  CAUSATION  OF  SEX 

interfere  with  the  rhythm  in  calculating  later  pregnancies. 
See  the  case  of  the  Queen  of  Spain's  family  in  Chapter  XXVI., 
p.  216. 

Failure  in  other  cases  is  due  to — an  irregular  type  of 
ovulation;  that  is,  instead  of  being  of  the  normal  28-day 
type,  so  that  four  weeks  elapse  between  each  ovulation, 
the  patient  goes  perhaps  only  21  days  or  even  30  to  35 
days. 

Allowing  28  days  or  four  weeks  for  the  average  menstrual 
periodicity  (the  external  sign  that  ovulation  has  occurred), 
we  get  13  ovulations  during  the  52  weeks  of  the  year. 
Of  course,  if  it  recur  every  21  days,  we  get  an  increased 
number  of  ovulations,  if  only  every  30  days  we  can  only 
allow  12  ovulation  periods,  with  a  thirteenth  every  sixth 
year. 

All  these  peculiarities  in  different  women  have  to  be 
allowed  for  when  forecasting  the  sex ;  but  with  the  following 
rules  and  examples  the  medical  attendant  of  any  pregnant 
woman  should  be  able  with  care  to  correctly  foretell  the 
sex  of  the  child  with  which  she  is  pregnant,  and  further  to 
tell  other  women  during  which  times  to  avoid  getting  preg- 
nant if  a  certain  sex  child  be  desired. 

This  can  roughly  be  done  with  the  aid  of  the  usual  ob- 
stetric tables,  for,  given  the  sex  and  the  birthday  of  the 
patient's  last  child,  the  ovulation  month  (and  naturally  the 
sex  of  that  ovum)  can  be  readily  found  from  the  tables. 
I  have,  however,  found  it  more  reliable  to  work  it  out  by 
means  of  the  forty  weeks'  plan  here  given. 

It  is  necessary  to  obtain  from  the  patient  the  following 
particulars  before  it  is  possible  to  forecast  the  sex  of  the 
coming  child: 

1.  How  often  do  your  menstrual  periods  occur  ? 

2.  How  many  days  does  each  usually  last  ? 

3.  Are  they  always  quite  regular  ? 

4.  What  was  the  date  when  your  last  child  was  born  ? 
(Year,  month,  and  day  must  be  known.) 

5.  Was  the  child  a  boy  or  girl  ? 

6.  Was  it  born  at  or  about  the  time  expected,  or  before 
or  after  its  expected  date  ?  If  either,  by  how  many  days 
or  weeks  ? 


FORECASTING  THE  SEX  OF  COMING  CHILD     183 

7.  How  long  did  you  suckle  the  child,  if  at  all  ? 

8.  When  did  the  menstrual  period  reappear  after  the 
confinement  ? 

9.  Give  the  dates  of  all  periods  seen  since  the  last  child 
was  born. 

10.  When  is  the  next  period  expected  ? 

11.  Have  there  been  any  miscarriages  since  baby  was 
born  ? 

12.  Give  the  dates  of  birth  and  sex  of  your  other  children. 

A  woman's  normal  period  of  gestation — that  is,  her  preg- 
nancy— lasts  for  280  days,  or  ten  months  of  four  weeks 
each — that  is,  forty  weeks  of  seven  days,  making  280  days 
in  all.  The  expression  "  nine  months  of  pregnancy  "  should 
be  abandoned,  because  inaccurate. 

Given  therefore  the  child's  birthday,  we  go  backwards 
forty  weeks  to  find  the  ovulation  month,  or  month  in  which 
the  ovum  was  fertilised  which  yielded  the  child.  The  sex 
of  this  child  being  known,  we  then  proceed  alternately  from 
this  ovulation  month  until  we  come  down  to  the  tenth 
ovulation  period  prior  to  the  expected  month  of  birth  of 
the  coming  child,  allowing  an  extra  or  thirteenth  ovulation 
between  each  December  and  January  of  the  year  following 
if  the  actual  period  dates  are  not  known. 

We  can  therefore  find  the  sex  of  the  ovulation  which  has 
just  been  fertilised  and  with  which  the  patient  is  now 
pregnant;  so  we  are  able  to  correctly  foretell  the  sex  of 
the  coining  child. 

Because  of  the  thirteen  ovulations  per  annum,  it  follows 
tjiat  if  the  October  ovulation  of  one  year  is  fertilised  the 
next  October  ovulation  will  be  of  the  opposite  sex,  because 
of  the  odd  or  thirteenth  month  or  ovulation  period  which 
has  to  come  between  the  two  Octobers;  so  that  if  a  patient 
has  a  child  in  one  month  of  one  year  and  another  child  in 
the  same  month  of  the  next  year,  the  sex  would  be  the 
opposite. 

Examples  of  this  are  to  be  found  in  the  family  of  her  late 
Majesty  Queen  Victoria,  thus:  first  child,  Princess  Victoria, 
the  Princess  Royal,  born  November  21,  1840;  second  child, 
King  Edward  VII.,  born  November  9,  1841;  also  in  the 
Duke  of  Edinburgh's  family:  first  child  a  boy,  born  October 


i84  THE  CAUSATION  OF  SEX 

1874;  second  a  girl,  born  October  1875;  and  again  in  the 
Duke  of  Connaught's  family:  first  child  a  girl,  born  January 
1882;  second  a  boy,  born  January  1883. 

The  following  few  instances  are  from  actual  cases  in  my 
own  practice  (they  do  not  exhaust  my  lists),  thus: 

Mrs.  T.  S.  C.  had  a  girl  February  6,  1914,  and  a  boy 
February  11,  1915. 

Mrs.  B.  L.  H.  had  a  girl  September  24,  1906,  and  a  boy 
September  2,  1907. 

Mrs.  W.  had  a  girl  May  12,  1909,  and  a  boy  May  26,  1910. 

Mrs.  F.  A.  had  a  girl  December  7,  1905,  and  a  boy 
December  18,  1906. 

Mrs.  C.  S.  G.  had  a  boy  born  July  2,  1899,  and  she  had  a 
girl  born  July  4,  1900. 

Mrs.  T.  P.  C.  had  a  boy  born  August  10,  1901,  and  she  had 
a  girl  born  August  13,  1902. 

Mrs.  L.  R.  had  a  boy  May  6,  1904,  and  a  girl  May  17,  1905. 

Mrs.  W.  T.  had  a  boy  September  3,  1906,  and  a  girl 
September  7,  1907. 

Mrs.  K.  P.  had  a  boy  August  24,  1907,  and  a  girl 
August  12,  1908. 

Mrs.  S.  C.  had  a  boy  February  15,  1914,  and  a  girl  Feb- 
ruary 25,  1915. 

If  instead  of  the  next  year  it  be  the  same  month  of  the 
next  year  but  one,  then  the  sexes  will  be  the  same,  thus : 

Mrs.  S.  P.  had  a  boy  September  1899,  and  she  had  a 
second  boy  September'1901,  because  September  1900  would 
have  given  a  girl. 

Mrs.  N.  L.  had  a  boy  February  21,  1897,  and  another 
boy  February  10,  1899 ;  for  February  1898  would  have  given 
a  girl. 

Mrs.  D.  H.  had  a  boy  February  17,  1906,  and  another 
boy  February  27,  1908;  for  February  1907  would  have  given 
a  girl. 

Mrs.  B.  had  a  boy  December  20,  1901,  and  another  boy 
December  7,  1903;  for  December  1902  would  have  given 
a  girl. 

Mrs.  T.  S.  had  a  boy  June  1901,  and  a  second  boy  June 
1903,  because  June  1902  would  have  given  a  girl. 


FORECASTING  THE  3EX  OF  COMING  CHILD     185 

Mrs.  R.  R.  D.  had  a  girl  July  1895,  and  a  second  girl 
July  1897,  because  July  1896  would  have  given  a  boy. 

Mrs.  M.  B.  had  a  girl  May  9,  1892,  and  another  girl 
May  12,  1894;  for  May  1893  would  have  given  a  boy. 

Mrs.  B.  L.  had  a  girl  June  24,  1900,  and  another  girl 
June  5,  1902;  for  June  1901  would  have  given  a  boy. 
Later  another  girl,  January  13,  1907,  and  still  another  girl 
January  5,  1909;  for  January  1908  would  have  given  a 
boy. 

Mrs.  V.  B.  had  a  girl  September  22,  1909,  and  another 
girl  September  14,  1911;  for  September  1910  would  have 
given  a  boy. 

Mrs.  B.  R.  S.  had  a  girl  December  13,  1907,  and  another 
girl  December  24,  1909;  for  December  1908  would  have 
given  a  boy. 

If  instead  of  being  the  same  month  two  years  running 
the  child  is  born  the  next  month  of  the  following  year,  the 
sex  will  be  the  same,  thus: 

Mrs.  C.  R.  R.  had  a  girl  May  5,  1901,  and  another  girl 
June  5,  1902,  because  May  1902  would  have  been  a  boy,  so 
the  next  month  (June)  gave  the  girl  it  was. 

Mrs.  F.  B.  had  a  girl  April  22,  1906,  and  another  girl 
May  27,  1907;  for  April  1907  would  have  given  a  boy,  so  the 
next  month  (May)  gave  the  girl. 

Mrs.  L.  G.  had  her  family  thus : 

Girl,  Ethel,  January  20,  1888.        1  ^ 
Girl,  Florence,  February  12,  iSSg.-j 
Girl,  Jessie,  March  19,  1890.  J  ^ 

Girl,  Lily,  July  6,   1892. 

Note  that  the  girls  Florence  and  Jessie  are  each  born 
thirteen  months  after  their  predecessors,  and  so  are  the 
same  sex. 

Mrs.  R.  L.  had  a  girl  May  9,  1897,  and  another  girl 
June  II,  1898;  for  May  1898  would  have  given  a  boy,  so 
June  gave  the  girl. 

Mrs.  T.  R.  S.  had  a  boy  February  3,  1906,  and  another 
boy  March  3,  1907;  for  February  1907  would  have  given 
a  girl,  so  March  gave  the  boy. 


i86  THE  CAUSATION,  OF  SEX 

Mrs.  B.  T.  had  a  boy  September  9,  1898,  and  another 
boy  October  20,  1899.  Here,  as  September  1899  would 
have  given  a  girl,  October  gave  the  male. 

Mrs.  S.  A.  B.  had  a  boy  November  4,  1908,  and  another 
boy  December  21,  1909;  for  November  1909  would  have 
given  a  girl,  so  the  next  month  gave  the  boy. 

Mrs.  C.  M.  had  a  boy  July  13,  1901,  and  another  boy 
August  22,  1902,  because  July  1902  would  have  given  a 
girl,  so  the  next  month  (August)  gave  the  boy. 

Her  third  child,  born  August  17, 1905,  was  a  girl,  because 
we  have  just  seen  August  1902  was  a  boy,  so  August  1903 
would  have  been  a  girl,  August  1904  would  have  been 
a  boy,  and  thus  August  1905  was  the  girl — i.e.  three  years 
after  the  last  boy. 

Hence,  if  children  are  born  in  the  same  month  an  odd 
number  of  years  apart  they  are  of  opposite  sex;  if  an  even 
number  of  years  intervene  they  are  of  the  same  sex,  thus: 

Mrs.  K.  C.  P.  had  twin  boys  on  March  25,  1888,  and  four 
years  later  to  the  actual  day,  viz.  March  25,  1892,  she  was 
again  dehvered  of  twin  boys;  so  that  because  the  births 
occurred  in  the  same  month  an  even  number  of  years  after- 
wards, she  had  the  same  sex  children  again.  That  she 
would  have  twins  could  not  of  course  be  foretold.  (See  also 
the  examples  in  the  case  of  the  Empress  of  Russia's  three 
last  daughters,  detailed  in  Chapter  XXVI. ,  p.  215.) 

In  the  following  cases  the  children  were  born  in  the  same 
month  a  varying  number  of  years  apart. 

Mrs.  W.  A.  had  her  children  thus: 

Alfred,  May  6,  1895. 

Arthur,  August  24,  1896. 

Louisa,  April  18,  1898. 

Alice,  November  10,  1899. 
[-Ernest,  March  22,  1902. 
LEdward,  March  10,  1904. 

Percy,  April  19,  1905. 

This  case  illustrates  two  points,  the  odd  and  the  even 
number  of  years  of  interval,  between  similar  months, 
giving  the  different  and  the  same  sex  respectively. 

Mrs.  T.  H.  had  a  girl  January  8,  1907,  and  a  boy 
January  13,  1910. 


FORECASTING  THE  SEX  OF  COMING  CHILD     187 

Mrs.  H.  C.  L.  had  a  girl  June  3,  1901,  and  a  boy  June  18, 
1904. 

Mrs.  H.  K.  had  a  girl  January  10,  1899,  ^.nd  a  boy  on 
January  17,  1906. 

Mrs.  T.  H.  W.  had  a  boy  August  15,  1904,  and  a  girl 
August  12,  1907. 

Mrs.  D.  B.  had  a  boy  November  12,  1906,  and  a  girl 
November  8,  1909. 

Mrs.  N.  F.  had  a  boy  November  17,  1903,  and  a  girl 
November  19,  1910. 

Mrs.  M.  S.  had  a  boy  December  9,  1907,  and  a  girl 
December  19,  1912. 

Mrs.  S.  C.  had  a  boy  February  15,  1914,  and  a  girl  on 
February  25,  1915. 

Mrs.  P.  K.  had  a  girl  June  19,  1903,  and  another  girl 
June  3,  1909. 

Mrs.  G.  had  a  girl  February  17,  1897,  and  another  girl 
February  8,  1901. 

Mrs.  H.  B.  had  a  girl  January  12,  1891,  and  another  girl 
January  5,  1899. 

Mrs.  K.  had  a  boy  April  27,  1903,  and  another  boy 
Aprir4,  1907. 

Mrs.  H.  L.  had  a  boy  September  2,  1897,  and  another 
boy  September  7,  1905. 

Mrs.  R.  S.  A.  had  a  boy  January  26,  1892,  and  another 
boy  January  21,  1898. 

Mrs.  J.  H.  had  a  boy  February  17,  1906,  and  another 
boy  February  27,  1908. 

We  therefore  get  the  general  rule  to  proceed  alternately 
from  the  known  date  and  month  of  a  child's  birth  down 
to  the  month  the  coming  child  is  expected  to  be  born  in. 
We  can  then  foretell  its  sex,  though  this  method  is  not 
so  invariably  correct  as  is  calculating  from  the  ovulation 
periods.     Thus : 

Mrs.  K.  M.  had  a  girl  May  1896,  and  a  boy  July  1897,  for 
May  1897  would  have  been  a  boy,  June  1897  would  have 
been  a  girl,  and  so  July  1897  was  a  boy. 

Mrs.  S.  C.  D.  had  a  girl  April  1902,  and  a  boy  October 


i88  THE  CAUSATION  OF  SEX 

1903;  for  April  1903  would  have  been  a  boy,  May  1903 
would  have  been  a  girl,  June  a  boy,  July  a  girl,  August 
a  boy,  September  a  girl;  and  so  October  was  a  boy. 

Mrs.  C.  had  a  girl  July  1900  and  a  boy  November  19, 
1905;  for  July  1901  would  have  been  a  boy,  July  1902  a 
girl,  July  1903  a  boy,  July  1904  a  girl,  July  1905  a  boy; 
so  August  1905  would  be  a  girl,  September  1905  a  boy, 
October  1905  a  girl,  and  thus  November  1905  was  a  boy. 

Mrs.  S.  W.  had  a  girl  October  1896,  and  another  girl 
May  1 901;  for  October  1897  would  have  been  a  boy,  October 

1898  a  girl,  October  1899  a  boy,  October  1900  a  girl,  October 

1 90 1  a  boy;  therefore  if  October  1901  would  have  been  a 
boy,  September  1901  would  have  been  a  girl,  August  a 
boy,  July  a  girl,  June  a  boy,  and  May  1901  a  girl,  which 
it  was. 

Mrs.  B.  R.  A.  had  a  girl  April  1886,  and  another  girl 
August  1888;  for  April  1887  would  give  a  boy,  April  1888 
a  girl.  Therefore  May  would  give  a  boy,  June  a  girl,  July 
a  boy,  and  August  the  girl  it  was. 

Mrs.  R.  had  a  girl  June  1888,  and  another  girl  November 
1893 ;  for  June  1889  would  give  a  boy,  June  1890  a  girl,  June 
1891  a  boy,  June  1892  a  girl,  and  June  1893  a  boy;  so  July 
1893  would  be  a  girl,  August  a  boy,  September  a  girl, 
October  a  boy,  and  November  1893  a  girl,  which  it  was. 

Mrs.  M.  B.  had  a  boy  April  1901,  and  a  girl  September 
1903;  for  April  1902  would  give  a  girl,  April  1903  a  boy, 
May  a  girl,  June  a  boy,  July  a  girl,  August  a  boy,  September 
a  girl,  which  it  was. 

Mrs.  G.  P.  H.  had  a  boy  February  1900,  and  a  girl  May 
1902;  for  February  1901  would  have  been  a  girl,  February 

1902  a  boy;  so  March  would  have  been  a  girl,  April  would 
have  been  a  boy,  and  May  was  a  girl. 

Mrs.  F.  G.  had  a  boy  July  1898,  a  girl  June  1902;  for  July 

1899  would  have  been  a  girl,  July  1900  a  boy,  July  1901 
a  girl,  July  1902  a  boy;  therefore  June  1902  gave  a  girl, 
which  it  was. 

Mrs.  L.  M.  had  a  boy  April  1899,  and  another  boy  February 
1903;  for  April  1900  would  have  been  a  girl,  April  1901  a 


FORECASTING  THE  SEX  OF  COMING  CHILD     189 

boy,  April  1902  a  girl,  April  1903  a  boy.  If  therefore  the 
child  was  expected  in  February  1903,  we  know  March  1903 
would  have  been  a  girl,  and  February  1903  would  give  the 
boy,  which  it  was. 

Mrs.  W.  L.  had  a  boy  August  1896,  and  another  boy 
November  1901 ;  for  August  1897  would  give  a  girl,  August 
1898  a  boy,  August  1899  a  girl,  August  1900  a  boy,  and 
August  1901,  a  girl;  so  September  1901  would  be  a  boy, 
October  1901  a  girl,  and  November  1901  a  boy,  which  it  was. 

Mrs.  G.  W.  G.  had  a  boy  May  1901,  and  another  boy 
August  1904;  for  May  1902  would  have  been  a  girl.  May 
1903  a  boy,  May  1904  a  girl,  June  1904  a  boy,  July  1904  a 
girl,  and  August  a  boy,  which  it  was. 

I  have  here  given  three  examples  of  each  kind  of  suc- 
cession— viz.  girl  followed  by  boy,  girl  by  girl,  boy  followed 
by  girl,  and  lastly  boy  by  boy — to  show  that  the  order  of 
birth  makes  no  difference  to  the  plan. 

In  the  following  cases  only  eleven  months  elapsed  between 
the  births,  so  the  sexes  will  be  the  same,  thus: 

Mrs.  R.  B.  had  a  boy  April  13,  1908,  and  another  boy 
March  26,  1909;  for  April  1909  would  have  given  a  girl, 
and  so  the  preceding  March  gave  a  boy. 

Mrs.  S.  R.  had  a  boy  February  9,  1914,  and  another  boy 
January  12,  1915;  for  February  1915  would  have  given 
a  girl,  so  the  prior  month  gave  a  boy. 

Mrs.  I.  had  a  boy  April  9,  1909,  and  another  boy 
March  18,  1910;  for  April  1910  would  have  given  a  girl. 

Mrs.  L.  H.  had  a  boy  March  10,  1899,  and  another  boy 
February  27,  1900;  for  March  1900  would  have  given  a  girl. 

Mrs.  R.  H.  had  a  girl  February  20,  1914,  and  another  girl 
January  17,  1915;  for  February  1915  would  have  given 
a  boy,  so  January  gave  the  girl. 

Mrs.  L.  G.  had  a  girl  August  6,  1892,  and  another  girl 
July  8,  1893 ;  for  August  1893  would  have  given  a  boy,  so 
July  gave  the  girl. 

In  the  following  cases  the  children  were  born  on  actually 
the  same  date  of  the  same  month,  a  varying  number  of  years 
apart. 


IQO  THE  CAUSATION  OF  SEX 

Mrs.  G.  P.  had  a  girl  September  15,  1896,  and  a  second  girl 
September  15,  1904. 

Mrs.  B.  E.  had  a  girl  May  13,  1900,  and  a  second  girl 
May  13,  1906. 

Mrs.  T.  C.  had  a  boy  July  5,  1901,  and  a  second  boy 
July  5,  1903. 

Mrs.  F.  had  a  boy  October  8,  1895,  and  a  girl  October  8, 
1898. 

Mrs.  G.  F.  T.  had  a  girl  December  6,  1897,  and  a  boy 
December  6,  1898. 

In  these  cases  the  patients  had  their  children  very  closely 
together — thus : 

Mrs.  T.  H.  F.  had  a  girl  January  6,  1908,  and  a  boy 
December  31,  1908. 

Even  if  we  count  December  31  as  a  January  1909  birth, 
they  come  right  to  each  other. 

Mrs.  H.  H.  B.  had  her  children  thus:  A  girl  Novem- 
ber 18,  1908,  and  a  boy  October  8,  1909  (prematurely).  He 
was  definitely,  to  my  knowledge,  expected  the  first  week 
of  November. 

Mrs.  T.  W.  had  a  girl  October  16,  1911,  and  a  boy  August 
20,  1912. 

The  following  interesting  cases,  correctly  foretold,  show 
that  the  birth  of  a  premature,  not  fully  developed  child 
must  be  taken  as  having  occurred  in  the  month  in  which  it 
was  expected,  and  not  in  the  month  wherein  birth  actually 
took  place ;  thus : 

Mrs.  L.  C.  G.,  who  expected  on  January  24,  1902,  was 
delivered  on  January  21  of  a  boy.  On  November  10  she 
engaged  me  to  attend  her  with  her  next,  which  she  expected 
the  middle  of  February  1903.  I  foretold  a  boy.  She  was 
delivered  prematurely  on  January  21,  1903,  of  another  boy, 
so  both  children  had  the  same  birthday  a  year  apart  !  It 
was  a  boy,  because  due  in  February;  thus:  January  1902 
gave  a  boy,  January  1903  should  give  a  girl,  and  February 
a  boy,  which  the  child  was,  though  born  prematurely  and 
not  fully  developed  in  January. 

Mrs.  B.  T.,  who  expected  about  the  middle  of  March, 


FORECASTING  THE  SEX  OF  COMING  CHILD     191 

was  confined  on  March  23,  1904,  of  a  girl;  she  expected 
again  May  25,  1906.  I  foretold  a  girl  again.  She  was 
prematurely  confined  on  March  19,  1906,  of  twin  girls.  As 
March  1904  was  a  girl,  March  1905  would  be  a  boy,  and 
March  1906  a  girl;  so,  too,  April  being  a  boy.  May  would 
give  the  girl  as  foretold.  Of  course  the  twins  were  not 
predicted.  So,  though  born  two  months  prematurely,  and 
properly  being  due  in  May,  this  forecast  was  actually 
correct,  as  it  would  have  been  had  the  twins  arrived  in  May. 

Twins  and  Sex  Prediction. — The  following  cases  of 
twins  show,  that  though  twinning  itself  could  not  be  fore- 
told, yet  in  the  case  of  boy  and  girl  twins  the  sex  of  the 
child  which  should  properly  have  been  born,  had  it  been 
a  single  birth,  could  and  would  have  been  correctly  pre- 
dicted. 

Where  the  twin  children  are  of  the  same  sex,  the  prediction 
is  no  more  diihcult  than  an  ordinary  single  birth. 

The  following  interesting  cases  contain  in  each  family 
a  case  of  boy  and  girl  or  "  pigeon-pair "  twins.  These 
instances  not  only  support  my  contentions,  but  also  show 
very  clearly  which  ovary,  anticipating  its  usual  rhythm, 
actually  ovulated  *'  out  of  its  turn,"  and,  owing  to  ovulating 
synchronously  with  its  fellow-ovary,  led  to  two  ova  being 
simultaneously  provided,  with  the  result  that,  both  being 
fertilised,  boy  and  girl  twins  were  born. 

The  cases  form  a  convincing  answer  to  the  reviewer  who 
considered  boy  and  girl  twins  were  not  explainable  by 
my  theory. 

Mrs.  L.  B.  T.  had  her  family  thus: 

Fred,  December  20,  1902.  "i  ^  n      ~1 

Srd  }  ^^^^^'  ^^g^^^  ^7.  1904.         1      J^         R 
Ethel,  March  3,  1906.  J  R   J      ^       _J 


Gladys,  June  4,  1907.  J 

W^inifred,  October  13,  1909.     -1  ] 

Joy,  April  14,  191 5.  J 


R 

R 


From  this  list,  it  will  be  seen  that  the  birth  of  Richard 
comes  right  or  correct  from  Fred,  and  also  with  Ethel; 
whereas  Dorothy  comes  wrong  from  Fred,  and  wrong  with 


192  THE  CAUSATION  OF  SEX 

Ethel,  who  followed.  It  is  plain,  therefore,  that  Dorothy 
was  the  interloper,  and  that  the  right  ovary,  which  provided 
Richard,  was  acting  normally  to  time,  and  that  the  left 
ovary,  which  provided  Dorothy,  acted  "  out  of  its  turn," 
so  that,  the  two  ova  being  provided  simultaneously,  twins 
resulted.  The  other  children  follow  each  other  quite 
correctly,  as  did  Ethel  from  Fred. 
Mrs.  W.  F.  had  her  family  thus: 


Dorothy,  January  21,  1889. 


]« 


Blanche,  January  22,  1891.  ^      -,  "~| 

Herbert,  December  4,  1895.  1  — 

Alfred,  October  15,  1897.  J  ^ 

Ethel,  July  22,  1901.  ]^ 

In  this  case  also  it  is  the  left  ovary  which  has  acted  "  out 
of  its  turn  "  and  supplied  an  ovum  at  the  same  time  as  the 
right,  so  that  pigeon-pair  twins  resulted. 

It  will  be  seen  that  Edward  comes  right  from  Blanche 
and  to  Herbert — whereas  Edith  cdmes  wrong  from  Blanche 
and  to  Herbert,  Herbert  comes  correctly  from  Blanche, 
as  Alfred  and  Ethel  also  do  from  Herbert.  The  case  shows 
that  Edward  was  the  correct  child  to  be  born  and  not 
Edith. 

Mrs.  F.  S.  had  her  large  family  thus: 

John,  February  3,  1875. 
Richard,  December  25,  1877. 
Thomas,  October  9,  1879. 
James,  June  5,  1881. 
Jane,  July  31,  1882. 
Edward,  November  12,  1884. 
Elizabeth,  December  2,  1886. 
Charlotte,  January  2,  1889. 
Ellen,  March  3,  1891. 

^^^^I^JTwins,  March  20,  1893. 

Robert,  February  8, 1895. 
Louisa,  January  2,  1897. 
Charles,  March  22,  1900. 


yM 


] 


r 


In  this  case  it  is  the  right  ovary  which  has  acted  "  out  of 
turn,"  and,  supplying  a  male  ovum  at  the  same  time  as 
the  left  did  a  female,  boy  and  girl  twins  resulted. 


FORECASTING  THE  SEX  OF  COMING  CHILD     193 

The  children  all  came  correctly  with  each  other  except 
the  twin  George,  who  comes  wrong  with  Ellen  and  with 
Robert;  his  companion  twin  Annie  comes  correctly  from 
Ellen  and  to  Robert,  as  these  two  do  to  each  other. 

Note  how  Charlotte  and  Louisa,  born  on  the  same  date 
of  same  month,  but  years  apart  (January  2,  1889,  to  1897) 
come  correctly  to  each  other. 

Jane,  born  July  31,  however,  is  wrong;  but  if  this  be 
counted  as  August — as  the  menstrual  month  has  not 
thirty-one  days  ! — all  the  children  come  right  with  each 
other. 

It  is  a  case  where  the  last  day  of  the  month  should 
properly  rank  as  a  day  of  the  month  following;  it  is  not 
possible  to  have  thirteen  ovulation  periods  analogous 
to  lunar  months  if  they  contain  more  than  twenty-eight 
days.  This  case  of  14  children  in  13  confinements  all 
coming  correctly  bears  out  the  criticism  of  a  reviewer,  that 
there  was  "  remarkable  concordance  with  expectation." 

In  the  following  cases  of  twins,  being  of  the  same  sex, 
they  naturally  are  both  correct,  if  one  is,  with  the  other 
members  of  the  family.  The  cases  imply  two  ova  from  the 
same  ovary,  in  these  cases  from  the  left  ovary,  evidently. 

Mrs.  B.  G.  had  her  family  thus: 

rFanny,  January  31,  1894. 
LLucy,  January  20,  1897. 

Frank,  June  26,  1901. 

Harriet^  T,    .  r 

Mary     j Twins,  July  14,  1903. -,  J 

Charles,  January  16,  1906.  -J         ^ 

Amy,  June  i,  1908.  -, 

Alfred,  June  7,  1911.  J 

Note  that  all  the  births  come  correctly,  and  that  January 
and  June  account  for  six  of  the  dates.  Fanny  comes  wrong, 
but  January  31  should  count  as  February  1894. 

Mrs.  P.  B.  had  her  family  thus: 


Lily,  March  23,  1895.  -j 

Leopold,  March  16,  1900. 


-p  IXwins,  March  13,  1897.  -, 


13 


194  THE  CAUSATION  OF  SEX 

Here  all  dates  are  correct,  and  all  are  in  the  month  of 
March. 

Mrs.  L.  R.  had  her  children  thus : 

Fll    ^j  Twins,  December  19,  1897, 

3.  Alice,  January  9,  1900. 

4.  Bertha,  April  13,  1901. 

The  double   ovulation  by  the   one   ovary  (the   left)  has 
not  affected  the  dates  of  the  subsequent  children. 

In  these  cases  the  right  ovary  has  evidently  supphed  the 
two  ova  at  one  time,  hence  twin  boys  resulted. 
Mrs.  T.  H.  B.  had  her  family  thus: 

1.  William,  January  18,  1861. 

2.  Alice,  January  2,  1862. 

3.  James,  October  12,  1864. 

4.  Walter,  June  9,  1866. 


5.  George,  April  19,  1868.  n 

iJ.,       AO/U. 

Charles.  June  23,  1872. 


Arthur)^  at  o 

Albert  1^^^^"'  ^P"^  ^''   '^70. 


6.  Arthur 
7 


]^ 


All  the  birth  dates  come  correctly,  and  the  sex  of  the 
sixth  confinement,  but  not  the  twinning,  could  have  been 
rightly  foretold,  as  the  eighth  child  also  would  have  been. 

Mrs.  F.  C.  E.  had  her  children  thus: 

I.  Boy,  September  30,  1908.     -j 

y   I  Tixrinc      IVTatr    T r\      JQII.    -^ 


gQyJTwins,  May  19,  191 1.  =j 
Boy,  January  18,  1913.         J 


This  is  an  interesting  case  where  September  30  must 
rank  as  October;  the  birth  date  of  the  twin  boys  would 
then  be  right,  and  could  have  been  correctly  foretold,  as 
would  the  fourth  child  from  the  date  of  the  twins. 

In  the  following  cases  an  error  in  the  month  in  which 
the  child  was  expected  to  be  born  led  to  my  forecast  being 
wrong.  Had  the  month  been  correctly  told  me  by  the 
mother  the  prophecy  would  have  been  correct ;  thus : 

Mrs.  W.  H.  had  a  girl  born  August  24,  1898.  She  ex- 
pected to  be  confined,  she  said,  the  third  week  of  July  1903. 


FORECASTING  THE  SEX  OF  COMING  CHILD      195 

I  therefore  foretold^on  April  15,  1903,  that  she  would  have 
a  girl  in  July  1903;  instead  she  was  delivered  of  a  fully 
developed  boy  at  i  a.m.  on  June  28.  Had  she  told  me  to 
expect  in  June,  I  should  have  of  course  correctly  foretold 
her  a  boy;  thus:  August  1898  gave  a  girl;  August  1899  would 
be  a  boy,  August  1900  a  girl,  August  1901  a  boy,  August 
1902  a  girl,  August  1903  a  boy,  hence  July  would  give  the 
girl  I  foretold,  while  June  1903  would  give  the  boy,  which 
was  born. 

Mrs.  M.  G.  had  a  boy  born  May  19,  1902.  She  expected, 
she  said,  to  be  confined  in  the  middle  of  August  1903.  I 
therefore  predicted  she  would  have  another  boy.  She  was 
delivered  on  July  27  of  a  fully  grown  girl.  I  should  have 
predicted  a  girl  for  July  had  that  month  been  given  to  me ; 
thus:  May  1902  was  a  boy;  May  1903  would  be  a  girl,  there- 
fore June  would  give  a  boy,  and  July  1903  a  girl,  which  it 
was,  the  first  four  children  having  all  been  boys. 

Therefore,  from  the  experience  of  these  and  other  cases,  I 
soon  learned  to  prophesy  like  this:  You  will  have  a  boy  if 
the  child  is  born  in  August,  and  a  girl  if  it  be  born  fully 
developed  in  July. 

Thus  Mrs.  R.  S.  said  she  expected  to  be  confined  at  the 
end  of  August  1902;  I,  however,  calculated  the  probable 
date  of  her  confinement  as  July  20,  1902;  I  therefore  pre- 
dicted, when  she  engaged  my  services  on  May  9,  1902,  that 
she  would  have  a  boy  if  the  child  was  born  in  August, 
but  a  girl  if  born  in  July.  She  was  delivered  of  a  girl  at 
3.30  a.m.,  July  11,  1902. 

Mrs.  T.  R.  expected  in  July;  I  calculated  her  date  as 
August,  so  prophesied  she  would  have  a  boy  in  July,  or 
girl  if  born  in  August  1902.  It  was  a  boy,  born  7  a.m., 
July  23,  1902. 

Mrs.  B.  expected,  she  said,  in  October  1903;  I  calculated 
her  date  as  September  26,  1903,  and  told  her  on  July  24, 
1903,  when  she  engaged  me  to  attend  her,  that  she  would 
have  a  girl  if  bom  in  September,  a  boy  if  born  in  October. 
She  was  delivered  of  a  girl,  midday,  September  26,  1903. 

These,  then,  are  some  only  of  the  cases  from  my  own 
practice,  in  which  I  have  correctly  foretold  the  sex;  in 
some  several  hours  before  the  birth,  in  others  weeks  and 


196  THE  CAUSATION  OF  SEX 

months  even,  ranging  from  two  to  six  months,  prior  to 
birth.  And  for  several  of  them  I  have  written  certificates, 
signed  not  only  by  the  laity,  that  I  did  correctly  forecast 
the  sex  of  their  children. 

Probably,  after  testing  my  plan  for  forecasting  the  sex  of 
a  child,  by  the  data  of  members  of  his  own  family,  the  reader 
will  be  sufiiciently  interested  to  test  it  by  the  Royal  and 
aristocratic  families,  the  dates  of  whose  children's  births  he 
can  readily  find  recorded  in  books. 

He  will  find  that  in  nearly  all  cases  the  sex  of  a  subse- 
quent child  could  have  been  correctly  foretold,  owing  to 
the  previous  child's  sex  and  birthday  being  known. 

In. some  few  cases  errors  may  appear,  owing  chiefly  to 
premature  births,  stillbirths,  miscarriages,  etc.,  of  which 
naturally  he  will  find  no  record ;  and  it  is  suggestive  that  in 
some  of  the  errors  he  will  find  an  unusually  long  interval 
has  occurred  between  the  two  births,  the  inference  being 
that  a  miscarriage  or  stillbirth  had  taken  place  in  between. 

Hence  a  doctor  in  actual  attendance  on  patients  whom 
he  knows,  will  obtain  a  larger  percentage  of  correct  results, 
than  would  be  obtained  by  looking  up  the  recorded  dates 
of  births,  in  families  of  whose  intimate  medical  history  he 
is  ignorant ;  for  he  would  not  know  the  mother's  menstrual 
rhythm,  nor  whether  a  child  was  bom  to  its  expected  time 
or  no. 


CHAPTER  XXIV 

DIFFICULTIES  AND  SOURCES  OF  ERROR 
EXPLAINED 

The  chief  causes  of  error  in  predicting,  as  also  in  determining 
the  sex  of  the  next  child  are  three  in  number : 

First. — Prematurity  or  post-maturity  of  birth  of  a 
precedent  child. 

Secondly. — Irregularity  of  menstruation  (ovulation)  as 
well  as  unusual  menstrual  rhythm.  Instead  of  the  28-day 
type  it  may  be — 

25  days'  interval ;  there  would  be  14  periods  for  one  year, 
15  during  the  second  year,  and  14  during  the  third  year, 
and  so  on. 

27  days'  interval;  there  would  be  13  periods  for  one  year, 
and  for  the  next  year  14  periods. 

This  mountain  in  the  eyes  of  one  reviewer,  I  have  practi- 
cally found  to  be  indeed  but  a  molehill. 

30  days'  interval;  there  would  be  12  periods  per  annum 
for  five  years,  with  a  thirteenth  in  the  sixth  year;  and  12 
again  in  the  seventh  and  following  years. 

Any  of  the  above,  if  calculated  as  of  the  28-day  type, 
and  always  giving  13  periods  per  annum,  will  lead  to  errors. 

Thirdly. — Ovulation  periods  which  occur  between  the 
22nd  and  29th  of  most  calendar  months,  inasmuch  as  they 
may  give  rise  to  a  birth  in  one  or  other  of  two  differently 
named  calendar  months,  are  a  fruitful  source  of  error; 
as  are  those  births  which  occur  between  the  ist  and  7th 
of  a  month.  Because  the  ovulation  which  gives  rise  to  them, 
is  in  a  calendar  month  of  different  name  to  that  for  the.  ovula- 
tions for  the  greater  part  of  that  particular  calendar  month. 

Under  the  heading  of  prematurity  of  birth  come  those 
cases  where  children  are  born  on  the  last  few  days  of  a 
month,  instead  of,  as  expected,  in  the  first  few  days  of  the 

197 


198  THE  CAUSATION  OF  SEX 

month  following.  A  few  days  make  all  the  difference 
between  a  right  and  a  wrong  forecast — e.g.  birth  on  May  30 
instead  of  June  2.  A  comparatively  trifling  domestic 
incident — e.g.  a  stumble  or  fall,  a  dose  of  medicine,  a  quarrel 
or  fright,  a  long  motor  drive,  and  many  others  besides — 
may  be  the  inciting  cause  of  the  earlier  onset  of  labour. 
Every  practical  obstetrician  meets  with  such  cases  and  in- 
cidents, though  they  are  not  mentioned,  and  do  not  appear 
alongside  the  Hst  of  the  dates  of  birth  of  the  children  in  the 
family  Bible.  In  many  cases,  too,  the  medical  attendant, 
by  the  use  of  his  midwifery  instruments,  so  expedites  the 
labour  that  he  makes  what  would  have  been  an  August  i 
birth  into  an  arrival  on  July  31. 

The  following  cases  of  families'  birth  dates  appear  to 
show  errors  when  worked  out  by  my  rule,  but  they  are  not 
really  so. 

Mrs.  L.  D.  S.  had  her  children  thus: 

Theoretical 
Ovulation  Period. 
r-Boy,  December  31,   1899     ..  ..     March  26,  1899. 


X 


rxjuy,   j^cticmuer   31,    1099      ..  ..      iviarcii  zo,  1099.  -1 

LGirl,  June  30,  1903  ..  ..     September  23,  1902. J 


The  above  case  shows  how  births  on  the  last  day  or  two 
of  a  calendar  month  should  usually  count  as  a  birth  in  the 
month  following.  My  method  of  forecasting  and  deter- 
mining sex  allows  only  28  days  to  an  ovulation  period, 
and  so  we  get  13  such  in  the  year.  It  is  therefore  un- 
reasonable, in  some  cases  at  least,  to  expect  births  late 
in  a  month,  or  the  first  day  or  two  of  a  month,  to  work  out 
correctly.  Certain  June  ovulation  periods,  e.g.,  will  give 
a  birth  in  the  last  day  or  two  of  March  or  the  first  few  days 
of  April;  so  that  one  ovulation  may  actually  cause  a  birth 
in  either  of  two  calendar  months.  Hence  we  get  errors 
from  this  cause. 

The  case  shows  that  an  ovulation  or  menstrual  "  month  " 
or  period  differs  from  a  calendar  month,  just  as  the  lunar 
months  do. 

In  the  above  example,  if  December  31,  1899,  be  reckoned 
as  January  1900,  and  June  30,  1903,  be  reckoned  as  July, 
the  births  come  correctly  to  each  other.  The  ovulation 
dates,  it  will  be  seen,  come  correctly  to  each  other. 


DIFFICULTIES  AND  ERRORS  EXPLAINED     199 

Mrs.  C.  0.  had  her  family  thus: 
Boy,  August  17,  1895, 


r>oy,  i\ugusL  17,  loy^,  "I  x  ^ 

[Girl,  July  30,  1898.  J  R 

If  reckoned  as  August  1898.  J 
Boy,  February  i,  1901.  1  x  ~1 
Boy,  May  31,  1907.  ^         R 

If  reckoned  as  June  1907.      J 


'} 


This  striking  example  shows  the  dates  of  birth  all  wrong, 
but  made  correct  if,  the  dates  of  the  calendar  months  not 
being  allowed  to  exceed  the  28  days  of  an  ovulation  period, 
the  births  are  reckoned  as  occurring  in  the  month  following. 

Mrs.  J.  E.  had  her  children  thus: 

Boy,  Joseph,  May  18,  1881. 

Girl,  Elizabeth,   January  29,  1883. 

Boy,  Edward,  June  2,  1884. 

Boy,  Charles,  November  10,  1885. 

Girl,  Susan,  March  25,  1890. 

If  January  29,   EHzabeth,   be  counted  as   a  February 
birth,  all  the  dates  are  correct. 
Mrs.  C.  E.  F.  had  her  family  thus: 

Boy,  September  30,  1898.-1^ 
Boy,  May  19,  1901.  4 

Boy,  January  18,  1903.     J^ 

If  September  30   counts   as   an    October  birth,  all  the 
dates  are  correct. 
Mrs.  B.  had— 

A  boy,  January  6,  1903.  -1 

Another  boy.  May  30,  1906.  J 

If  May  be  counted  as  June,  the  dates  come  right. 
Mrs.  T.  H.  F.  had— 

A  girl.  May  31,  1898. 

Another  girl,  February  16,  1900. 

So  if  May  31  is  counted  as  June,  these  dates  come  right. 
Mrs.  L.  H.  C.  had  her  family  thus: 

Girl,  May  30,  1901. 

Expected  in  June  by  the  patient  and  myself, 
her  doctor. 
Boy,  March  18,  1903. 

Expected  by  me  March  17. 
Boy,  June  18,  1904, 

Expected  by  me  second  week  of  June. 
Girl,  December  13,  1905. 


202  THE  CAUSATION  OF  SEX 

Boy  No.  I,  born  on  December  31,  should  rank  as  a 
January  1878  child;  he  then  comes  right  to  No.  2. 

No.  2  and  No.  6  come  right,  but  all  the  others  are  wrong. 
The  patient  cannot  have  been  regularly  of  the  28-day  type 
of  menstruation  and  ovulation. 


Case  B. 


1.  Girl,  April  6,  1886. 

2.  Girl,  March  24,  1887. 

3.  Boy,  Octobers!,  1888. 

4.  Girl,  July  30,  1890. 

5.  Girl,  March  6,  1892. 

6.  Boy,  September  13,  1893.: 

7.  Boy,  October  i,  1894. 

8.  Girl,  March  i,  1899. 

9.  Boy,  September  21,  1903. 


Known   to   be   premature    (?  7- 

month  child).  -1 

Also  if  reckoned  as  November  J 
And  if  reckoned  as  August    J 


] 


This  case  illustrates  different  points  already  alluded  to, 
3  and  4  being  correct  to  each  other,  also  when  counted  as 
births  in  the  succeeding  months,  in  which  case  3  would 
also  come  right  with  2;  though  5  comes  wrong  to  4  if  this 
is  reckoned  as  August.  But  at  least  six  dates  then  come 
right. 

The  following  is  a  similar  case  from  my  own  lists : 

Mrs.  B.  M.  L.  had  her  family  thus: 

I.  Girl,  May  9,  1852.    n 


■]- 


2.  Girl,  May  12,  1854 

3.  Boy,  June  5,  1856. 

4.  Girl,  October  29,  1858 

5.  Boy,  March  i,  1861. 

6.  Boy,  October  29,  1862 

7.  Boy,  June  17,  1864. 

8.  Boy,  May  8,  1866. 

9.  Boy,  September  29,  1869. 

Here  2  and  3  come  right  to  the  first  born.  Then  4,  6, 
and  9,  are  awkward  dates  at  the  months'  end.  If  4  is 
counted  as  November,  she  comes  right  with  3  and  5;  but 
if  6  is  counted  as  November  the  dates  come  wrong  ! 

If  9  is  counted  as  October,  he  comes  right  to  8,  not  other- 
wise. Note  that  3  and  7  come  right  to  each  other.  Ths 
case  illustrates  that  the  last  day  or  two  of  a  month  and  the 
first  few  days  (No.  5,  March  i)  give  the  most  mistakes. 


DIFFICULTIES  AND  ERRORS  EXPLAINED    201 

Similarly,  Mrs.  K.  C.  had — 

A  girl,  June  29,  1893. 
Another  girl,  June  30,  1899. 

Both  come  right  with  each  other,  as  they  would  were 
each  date  counted  as  a  day  in  July. 

Case  reported  by  Mr.  C.  C.  Hurst,  sent  him  by  Mr.  G.  P. 
Mudge: 


1.  Girl,  May  31,  1880. 

2.  Girl,  November  20,  1881 

3.  Girl,  March  27,  1883. 

4.  Girl,  June  4,  1884. 

5.  Girl,  November  29,  1885.^ 

6.  Boy,  December  28,  i88( 


X 


This  case  was  quoted  in  a  scientific  journal  as  rather 
disproving  the  accuracy  of  my  theory  !  But  if  May  31 
is  counted  as  June  all  the  dates  come  correct.  One  only 
of  the  predictions  comes  wrong,  as  the  dates  stand,  out  of 
the  six ! 

In  writing  of  the  above  case,  it  was  said:  "A  theory 
must  not  be  judged  too  severely  upon  the  basis  of  a  few 
exceptions.  Ovulation  may  have  been  suspended  or  ir- 
regular, or  other  disturbing  causes  may  temporarily  have 
disturbed  the  normal  sequence."  The  writer  did  not, 
however,  realise  that  usually  there  cannot  be  allowed 
more  than  28  days  in  a  calendar  month,  if  the  calculations 
are  based  on  a  28-day  ovulation  interval.  Why  Mr.  Hurst 
maintained  that  No.  3  came  wrong  from  No.  2  child,  I 
know  not. 

The  following  two  cases  were  sent  me  by  Professor  L. 
Doncaster.  Both  show  irregularity  of  ovulation  from  some 
evidently  temporary  cause;  and  though  many  of  the  dates 
come  wrong,  both  cases  illustrate  certain  of  my  contentions. 

Case  A. 

1.  Boy,  December  31,  1877.       If  January  1878-1 

2.  Boy,  August  4,  1879.  J 

3.  Girl,  June  18,  1881. 

4.  Girl,  March  7,  1883. 

5.  Boy,  January  2,  1885. 

6.  Girl.  August  6,  1886.  — ' 


202 


THE  CAUSATION  OF  SEX 


Boy  No.  I,  born  on  December  31,  should  rank  as  a 
January  1878  child;  he  then  comes  right  to  No.  2. 

No.  2  and  No.  6  come  right,  but  all  the  others  are  wrong. 
The  patient  cannot  have  been  regularly  of  the  28-day  type 
of  menstruation  and  ovulation. 


Case  B. 


Girl,  April  6,  1886. 
Girl,  March  24,  1887. 
Boy,  October  31,  1888. 
Girl,  July  30,  1890. 
Girl,  March  6,  1892. 
Boy,  September  13,  1893. 
Boy,  October  i,  1894. 
Girl,  March  i,  1899. 
Boy,  September  21,  1903. 


Known   to   be   premature    (?  ; 

month  child) .  -1 

Also  if  reckoned  as  November ^ 
And  if  reckoned  as  August    J 


] 


This  case  illustrates  different  points  already  alluded  to, 
3  and  4  being  correct  to  each  other,  also  when  counted  as 
births  in  the  succeeding  months,  in  which  case  3  would 
also  come  right  with  2;  though  5  comes  wrong  to  4  if  this 
is  reckoned  as  August.  But  at  least  six  dates  then  come 
right. 

The  following  is  a  similar  case  from  my  own  lists : 

Mrs.  B.  M.  L.  had  her  family  thus: 

1.  Girl,  May  9,  1852.    i 

2.  Girl,  May  12,  1854. J  ^ 
Boy,  June  5,  1856.  J       _ 
Girl,  October  29,  1858. 
Boy,  March  i,  1861. 
Boy,  October  29,  1862. 
Boy,  June  17,  1864. 
Boy,  May  8,  1866. 
Boy,  September  29,  1869. 


Here  2  and  3  come  right  to  the  first  born.  Then  4,  6, 
and  9,  are  awkward  dates  at  the  months'  end.  If  4  is 
counted  as  November,  she  comes  right  with  3  and  5;  but 
if  6  is  counted  as  November  the  dates  come  wrong  ! 

If  9  is  counted  as  October,  he  comes  right  to  8,  not  other- 
wise. Note  that  3  and  7  come  right  to  each  other.  Ths 
case  illustrates  that  the  last  day  or  two  of  a  month  and  the 
first  few  days  (No.  5,  March  i)  give  the  most  mistakes. 


DIFFICULTIES  AND  ERRORS  EXPLAINED    203 

Cases  of  Apparent  Errors,  due  to  Known 
Prematurity  of  Birth. 

Mrs.  L.  B.  H.  had  her  family  thus: 

Ovulation  Dates. 
I.  Boy,  March  20,  1863.         -i  ^       June  13,  1862.  -. 


>]■ 


This  boy  was  premature     I  | 

and  stillborn.  I 

3.  Girl,  February  27,  1866.    —I  May  23,  1865.  ^ 

4.  Girl,  June  8,  1870.  J^  September  i,  1869.  J 

5.  Girl,  September  25,  1871.  J^  December  19,  1870.  J 

It  will  be  seen  here  that  the  second  boy  was  premature 
and  stillborn,  being  expected  in  December,  the  first  five  days 
of  which  would  still  be  a  February  ovulation.  This  makes 
his  date  come  wrong  from  his  predecessor.  After  the 
actual  birth  of  the  second  child,  the  dates  of  the  girls  follow 
correctly. 

Mrs.  McC.  had  her  family  thus: 

1.  Girl,  July  17,  1907.  n 

2.  Boy,  November  28,  1908.  4 

3.  Boy,  January  6,  1910.  4 

4.  Girl,  February  6,  191 1.  -J 

This  girl  was  not  expected 
till  mid-March. 

5.  Boy,  February  11,  1912. 

In  this  case  the  premature  birth  of  the  girl  renders  her 
birth  date  wrong  from  her  predecessor,  the  boy.  No.  3; 
had  she  arrived  in  March,  her  date  would  have  been  correct. 
In  reckoning  for  the  next  child,  the  actual  date  of  birth 
of  No.  4  must  be  taken,  and  not  the  expected  date;  and  this 
helps  to  prove  that  ovulation  starts  again  soon  after  the 
actual  birth  date,  and  not  after  the  expected  date.  Note 
how  No.  5  comes  right  from  the  actual  birth  date  of  No.  4, 
not  from  her  expected  date. 

I  attended  Mrs.  L.  S.  H.  with  her  family,  thus : 

.1.  Boy,  October  31,  1898. 
Expected  mid-October. 

2.  Boy,  October  i,  1900. 

Expected  October  8. 

3.  Boy,  April  6,  1904. 

Expected  April  7. 

4.  Boy,  July  15,  1906. 

Expected  beginning  of  August.     Died  on 
second  day;  premature  and  jaundiced. 


204 


THE  CAUSATION  OF  SEX 


y 


Had  this  fourth  child  come  when  due,  all  the  dates  would 
be  correct.     His  known  prematurity  makes  his  date  wrong. 
Mrs.  T  V.  had— 

A  girl,  April  4,  1915. 

Expected  April  9,  191 5. 
A  boy,  September  22,  1916. 

The  boy  was  expected  by  his  mother  and  myself  in  mid- 
October.  As  his  birth  date  stands,  he  comes  wrong  from 
his  sister,  but  the  absence  on  war  service  of  the  husband 
makes  the  expected  time  of  birth  practically  certain.  Had 
the  child  been  born  in  October,  the  dates  would  be  correct. 

Mrs.  J.  C.  T.  had  her  family  thus: 

1.  Boy,  December  29,  1887. 

He  was  two  weeks  overdue. 

2.  Girl,  December  9,  1888. 

Was  a  week  premature. 

3.  Boy,  May  i,  1890. 

About  the  expected  time. 

4.  Girl,  May  19,  1892. 

Was  at  least  two  weeks 
premature ;  due  first  week 
in  June. 

5.  Girl,  July  17,  1901. 

Considered  two  to  three  weeks 
premature;  expected  in 
August. 

No.  4.  being  prematurely  born  in  May  instead  of  June, 
comes  wrong  from  No.  3.  Had  she  been  born  in  June  as 
expected,  she  would  have  been  right. 

No.  5,  also  premature,  comes  wrong  from  the  actual 
birth  date  of  No.  4.  Had  she  arrived  when  expected,  the 
dates  would  have  been  correct.  The  case  shows  two  errors 
due  entirely  to  prematurity. 

Mrs.  G.  H.  B.  had  her  family  thus: 

Ovulation  Dates. 

I.  Boy,  June  18,  1910.  ^   _^      September  11,  1909. 

Bom  two  days  before  ex- 


X 

x 

R 

pected. 
Boy,  August  25,  191 1.  : 

Born  three  to  four  weeks 

prematurely;  expected 

in  September. 
Boy,  May  17,  1914. 


R  November  18,  1910. 


December  19 10. 
August  10,  1913. 


DIFFICULTIES  AND  ERRORS  EXPLAINED    205 

This  case  shows  boy  No.  2  prematurely  born,  and  so 
coming  wrong  to  No.  i.  Had  he  been  born  when  expected, 
in  September,  the  birth  dates  would  be  right,  as  also  would 
be  his  actual  ovulation  date,  in  December  1910,  to  September 
1909.  Note  that  the  ovulation  date  of  his  actual  birthday 
is  wrong  from  the  ovulation  date,  September  1909,  of  No.  i. 

No.  3  comes  correctly  from  the  actual  birthday  of  No.  2, 
August  1911,  and  so  does  his  ovulation  date,  August  1913, 
from  the  presumed  ovulation  date  for  the  actual  birthday  of 
No.  2;  because  ovulation  starts  after  the  actual  birthday, 
not  after  the  expected  birth  date.  The  case  also  shows 
that,  to  predict  or  to  determine  the  sex  of  the  next  child, 
the  actual  date  of  birth  must  be  used,  and  not  the  expected 
date. 

A  Case  of  Artificial  Prematurity,  Labour  being 

INDUCED. 

Mrs.  F.  O.  had  her  children  thus: 

1.  Boy,  born  January  17,  1906.  This  child,  a  full-time 
one,  was  born  when  expected,  but  owing  to  a  pelvic  con- 
traction the  doctor  said  induction  of  premature  labour 
would  have  to  be  performed  in  any  subsequent  pregnancy. 

2.  Boy,  born  April  5,  1908,  labour  having  been  induced 
a  month  prematurely,  the  child's  birth  being  expected 
normally  on  or  about  May  5,  1908.  As  the  boy  No.  i  was 
born  January  1906,  January  1908  would  have  given  a  male, 
February  a  female,  March  a  male,  April  a  female,  and  May 
1908  a  male,  which  the  child  No.  2  was,  though  his  birth 
had  been  expedited,  so  that  he  arrived  in  April. 

3.  Girl.  Her  birth  was  expected  about  September  15, 
1912.  Labour  was  induced  on  August  25,  1912,  and  the 
girl  was  born. 

Now,  by  my  theory  we  must  reckon  from  the  actual 
birth  date  of  No.  2  child — viz.  April  1908  (not  from  the  ex- 
pected month,  May).  As  April  1908  gave  a  boy,  April 
1910  and  1912  would  have  given  males,  so  May  1912  would 
give  a  female,  June  a  male,  July  a  female,  August  a  male, 
and  September  1912  a  female,  which  the  child  was,  though 
her  birth  was  brought  about  prematurely  in  August. 


2o6  THE  CAUSATION  OF  SEX 

4.  Girl.  Expected  on  April  26,  19 14;  delivery  was  de- 
layed, and  she  was  eventually  delivered  by  Caesarean  section 
on  May  i,  1914.  As  above,  we  reckon  from  the  actual 
birth  date  of  No.  3 — viz.  August  1912 — which  was  a  girl; 
so  August  19 13  would  have  given  a  male,  August  19 14  a 
female,  and  June  and  April  19 14  would  have  given  the 
female,  which  the  child  was,  though  actually  artificially 
delivered  on  May  i,  1914. 

Tabulated  the  births  occurred  thus — 

1.  Boy,  January  17,  1906. 

2.  Boy,  April  5,  1908, 

Due  May  5,  1908. 

3.  Girl,  August  25,  1912. 

Due  September  15,  1912. 

4.  Girl,  May  i,  1914. 

Due  April  26,  1914. 


The  case  is  instructive  as  showing  we  must  calculate  from 
the  actual  date  of  birth  if  we  wish  to  forecast  or  to  determine 
the  sex  of  a  subsequent  child,  and  not  from  the  expected 
date  of  birth. 

It  shows  that  ovulation  evidently  begins  again  a  "  month  " 
or  period  after  the  actual  birth,  whether  premature  or  not, 
and  whether  naturally  or  artificially  induced.  The  case 
is  very  convincing  of  alternate  ovulation  of  male  and  female 
ova,  and  thus  very  strongly  supports  my  theory.  Note 
that  all  the  actual  birth  dates  come  wrong  to  each  other, 
but  that  the  actual  birth  dates  all  come  right  to  the  ex- 
pected birth  dates  of  the  succeeding  children. 

That  women  do  not  all  conform  to  the  28-day  type  of 
menstruation  and  ovulation  is  a  fact  known  to  all,  and  I 
have  had,  sinee  the  first  edition  of  this  book  was  written, 
most  extraordinary  cases  of  ovulation  irregularity  sent  to 
me,  and  these,  besides  constituting  the  most  difficult 
cases  to  correctly  determine  the  sex  for,  account  for  many 
contradictory  cases. 

In  the  following  case  the  type  is  certainly  not  a  28-day 
type,  for  all  the  birth  dates  come  incorrectly  with  each 
other,  save  i  and  3  to  each  other. 


DIFFICULTIES  AND  ERRORS  EXPLAINED    207 

Mrs.  M.  L.  L.  had  her  family  thus: 

1.  Boy,  September  12,  1885.-, 

2.  Girl,  July  i6,  1887.  r 

3.  Girl,  September  15,  1890.-' 

4.  Girl,  August  25,  1892. 

5.  Boy,  June  21,  1896. 

It  is  not  necessary  to  detail  others. 

Finally  I  give  two  convincing  cases. 
Mrs.  W.  P.  S.  had  her  family  thus: 

I.  Boy,  December  8,  1900. 

Two  months  premature ;  ex- 


pected m  February  190 1.  Ir 

2.  Girl,  December  16,  1904.  -1 

3.  Girl,  December  17,  1908.  J^ 

4.  Girl,  December  9,  1910.  J^ 


A  strikingly  confirmatory  case.  The  last  three  children 
were  born  exactly  when  expected.  Note  that  each  of  the 
four  was  born  in  a  December. 

Mrs.  W.  L.'s  family  came  thus: 

1.  Girl,  August  3,  1885. 

2.  Girl,  September  10,  1886. 

3.  Girl,  September  16,  1888. 

4.  Girl,  January  17,  1890.  ^ 

5.  Boy,  June  15,  1894. 

6.  Boy,  September  20,  1897. 

7.  Girl,  September  29,  1898. 

8.  Girl,  September  3,  1900. 

Note  how  five  of  the  births  occurred  in  the  month  of 
September  ! 

The  above  is  a  good  example  of  a  fairly  large  family 
with  "  remarkable  concordance  with  expectation,"  and 
thoroughly  corroborates  the  theory.  Well  might  one 
of  my  reviewers  write:  "  The  theory  works  out  with  curious 
exactitude  in  the  cases  tested  "  by  him.  Children  i  and 
2  support  the  statement  that  13-months  apart  children 
are  of  the  same  sex;  Nos.  2  and  3,  7  and  8,  show  that  births 
in  the  same  month  an  even  number  of  years  apart  are  of 
the  same  sex;  while  Nos.  6  and  7  prove  that  the  same 
month  next  year  gives  a  change  in  sex. 


CHAPTER  XXV 

A   CONSIDERATION    OF 

THE    PRE-   AND    POST- MENSTRUAL   THEORY 

OF   SEX   DETERMINATION 

Among  the  fairly  widely  credited  means  of  securing  a  boy 
or  girl  as  wished  is  the  belief  that  fertilisation  must  take  place 
just  before  or  just  after  a  menstrual  period,  to  secure  the 
sex  desired — the  so-called  "  pre-  and  post-menstrual  theory  " 
of  sex  causation. 

This  idea  I  find,  like  a  great  majority  of  others,  has  no 
foundation  of  fact  to  rest  on;  and  I  am  further  struck  with 
the  self-condemnatory  fact  that,  while  one  section  of  the 
public  believes  that  just  before  a  period  gives  a  boy,  and 
after  a  girl;  an  equally  numerous  section  believes  just  the 
opposite — viz.  that  just  before  a  period  gives  a  girl,  and 
after  a  boy. 

I  have  no  hesitation  in  saying  that  both  are  entirely 
wrong,  and  that  the  time  of  fertilisation  is  quite  immaterial; 
and  I  have  by  me  a  large  number  of  clinical  cases  in  detail 
to  disprove  either  contention. 

First  pointing  out  the  difficulty  of  explaining  by  this 
view  those  cases  where  pregnancy  occurs  before  menstrua- 
tion has  eyer  begun,  as  in  young  girls  in  hot  climates  especi- 
ally— for  the  children  in  such  cases  are  not  of  one  sex  only — 
as  well  as  those  cases  of  pregnancy  after  the  cessation  of 
menstruation ;  there  are  the  quite  numerous  cases  to  explain 
of  pregnancy  occurring  during  the  lactational  absence  of 
menstruation,  where  also  the  children  are  not  of  one  sex 
only,  as  they  should  be  if  the  ovum  fertilised  prior  to  the 
menstrual  show  always  gave  children  of  one  sex  only. 

The  following  extracts  from  letters  from  patients  serve 
to  show  how  worthless  the  idea  is. 

208 


PRE-  AND  POST-MENSTRUAL  THEORY      209 

Mrs.  P.  C.  R.  writes:  "This  date  [of  insemination]  was 
just  before  the  period" — a  girl  was  born;  and  "the  last 
girl  was  just  after ,  so  that  idea  is  knocked  on  the  head 
and  proved."    Emphasised  words  as  in  original  letter. 

This  case  is  most  convincing,  as  the  patient,  who  most 
earnestly  longed  for  a  boy,  had  been  strongly  advised  to 
attempt  fertilisation  only  after  a  period.  This  she  did, 
and  obtained  a  girl.  Being  then  advised  by  other  friends 
to  try  just  before  the  period,  and  a  boy  would  surely  result, 
she  obtained  the  second  girl  she  writes  of  above.  So  that 
this  one  patient  disproves  both  ideas.  It  shows,  as  I  con- 
tend, that  a  girl  can  be  obtained  by  either  pre-  or  post- 
menstrual  fertilisation,  provided  the  ovum  is  female. 

Mrs.  V.  B.,  who  has  had  four  boys  and  no  girls,  writes 
thus:  "  I  think  all  my  babies  have  been  started  directly 
after  a 'period." 

This  case  necessarily  disproves  the  idea  that  girls  are 
due  to  fertilisation  just  after  the  period  only,  though  sup- 
porting the  idea  that  this  leads  to  the  birth  of  a  boy. 

Mrs.  G.  W.,  who  has  had  three  girls,  writes  that  she  has 
"  found  that  immediately  after  has  produced  my  girls." 

This  case  and  the  previous  one  remarkably  contradict 
each  other. 

Mrs.  L.  P.  writes  in  her  letters  to  me  thus  (the  words  in 
italic  are  emphasised  in  the  original  letters) :  "  I  am  anxious 
to  have  a  son,  and  have  already  had  two  daughters.  One 
thing  I  do  know  is  that  both  my  girls ^  have  been  made  the 
day  after  my  period  is  over.  It  is  no  use  my  trying  directly 
after  ;  I  am  sure  it  would  be  a  girl,  for  directly  after  the 
period  has  meant  a  daughter  each  time  so  far."  After 
consulting  me,  I  wrote  and  advised  that  the  time  of  fertihsa- 
tion  was  immaterial,  as  long  as  the  correct  ovum  was  fer- 
tilised according  to  my  rules.  She  wrote  me  later  thus: 
"  I  am  going  to  have  a  baby.  It  was  directly  after  my 
monthly  trouble.  /  followed  your  advice  entirely,  and  this 
is  the  result."  "  My  little  son  was  born  quite  hale  and 
hearty,  a  splendid  specimen." 

Here  is  a  case  of  a  patient  getting  her  desired  son  by 
fertiHsation  directly  after  the  period  I  advised,  although 
she  had  been  convinced  that  directly  after  led  always  to 

14 


210  THE  CAUSATION  OF  SEX 

a  girl.  It  shows  that  post-menstrual  fertiHsation  can  give 
either  sex.  She  had  had  two  girls  by  post-menstrual 
fertilisation,  and  secured  her  boy  also  by  post-menstrual 
fertilisation,  because  the  ovum  of  that  period  was,  as  I  had 
told  her,  a  male  one.  I  had  correctly  determined  the  sex 
of  her  next  child  for  her. 

Mrs.  R.  V.  had  two  boys.  Insemination  in  both  cases 
took  place  only  just  after  the  period  ceased.  She  then 
had  a  girl,  owing,  she  says,  to  "  connection  in  the  last  two 
weeks  of  her  menstrual  interval  only  " — i.e.  just  before  the 
next  period  began. 

This  case  shows  two  boys  post-menstrual,  and  a  girl 
pre-menstrual. 

Mrs.  S.  C.  B.  had  her  children  thus: 

1.  A  boy,  December  24,  1902;  born  on  actual  day  expected. 

2.  A  girl,  August  18,  1905;  expected  on  August  21. 

"  In  both  cases  insemination  took  place  immediately 
after  a  period."  "  No  precautions  were  taken  just  before 
a  period,  but  always  after  one,  except  when  the  second 
child  was  wanted." 

Here  we  see  a  child  of  each  sex  due  to  fertilisation  after 
a  period,  showing  it  is  not  the  time  of  fertilisation  which 
counts. 

Mrs.  S.  H.  D.  had  one  girl  followed  by  four  boys — thus: 

First  child :  Girl  stillborn  May  7,  1907.  No  other  details  obtainable. 

Second  child:  Last  seen  period  began  July  15,  stopped  July  20, 
1907.  Only  inseminations:  July  21,  22,  23,  1907.  Boy  born  April 
30,  1908;  expected  April  27  to  29,  1908. 

Third  child:  Last  seen  period  began  April  25,  stopped  May  i, 
1909.  Inseminations:  May  8  and  May  30,  1909.  Boy  born  Feb- 
ruary 17,  1910;    expected  February  12,  1910. 

Fourth  child:  Last  seen  period  began  May  23,  stopped  May  29, 
191 1.  Inseminations:  May  30  and  June  4,  191 1.  Boy  born 
February  27,  1912  ;  expected  March  6  to  11,  1 912. 

Fifth  child:  Last  period  began  February  24,  stopped  March  i, 
1 9 14.  Inseminations:  March  2,  6,  9,  191 4.  Boy  born  December  9, 
1914;  expected  December  7  to  14,  1914. 

It  is  evident  in  No.  3  that  the  May  8  insemination  fertiHsed 
the  ovum  of  the  last  period  seen,  because  the  next  period 
due  (?  May  23)  did  not  appear,  and  on  May  30  she  was 
already  pregnant. 


PRE-  AND  POST-MENSTRUAL  THEORY      211 

Tabulated  the  births  come  thus : 

1.  Girl,  May  7,  1907. 

Stillborn.  |x 

2.  Boy,  April  30,  1908.        "T 

3.  Boy,  February  17,  1910J 

4.  Boy,  February  27,  1912  J 

5.  Boy,  December  9,  1914J 

If  April  30,  the  date  of  No.  2,  had  been  a  few  days  earlier  — 
i.e.  post-maturity — he  would  still  be  right  with  No.  3,  but 
wrong  with  No.  i;  whereas  if  the  birth  is  reckoned  as  a 
May  one  (prematurity),  it  comes  correct  to  No.  i,  but 
wrong  with  No.  3.  The  case  supports  my  theory  fully,  and 
also  shows  that  post-menstrual  impregnation  in  this  case 
gave  rise  to  four  boys.  I  contend  the  time  of  fertilisation 
is  immaterial  to  sex  production;  it  depends  on  what  ovum 
is  then  available. 

I  now  give  short  details  of  some  others  of  my  actual 
cases. 

Mrs.  L.  C. :  Last  menstrual  period  stopped  April  19,  1901.  Coitus 
April  25,  1 90 1.  Boy  born  January  21,  1902;  expected  January  24, 
1902. 

Mrs.  R. :  Last  period  stopped  August  2,  1901.  Coitus  August  5, 
1901.     Boy  born  May  2,  1902;  expected  May  10,  1902. 

Mrs.  B.  H.:  Period  stopped  January  5,  1912.     Coitus  January  6, 

1912.  Boy  born  October  8,  1912;  expected  October  12,  1912. 
Mrs.  S. :  Period  stopped  March  23,  191 1.     Coitus  March  24,  191 1. 

Boy  born  December  25,  191 1 ;  expected  December  28,  191 1. 

Mrs.  B. :  Last  period  stopped  December  13,  1905.  Coitus  Decem- 
ber 17,  1905.  Girl  born  September  19,  1906;  expected  Septem- 
ber 23,  1906. 

Mrs.  C.  T. :  Period  stopped  January  6,  1913.     Coitus  January  11. 

1 91 3.  Girl  born  October  10,  191 3;  expected  October  9,  191 3. 
Mrs.  C.  C. :  Period  stopped  April  25,  1908.     Coitus  April  26,  1908. 

Girl  born  January  31,  1909.     Child  born  exactly  280  days  after. 

Mrs.  J.:  Period  stopped  August  9,  1909.  Coitus  August  11,  1909. 
Girl  born  May  24,  1910 ;  expected  May  16,  1910. 

The  former  four  cases  show  boys  born  as  a  result  of 
fertilisation  immediately  after  cessation  of  a  period;  the 
second  four  cases  show  girls  born  under  similar  conditions. 

Mrs.  B.  T. :  Period  stopped  December  5,  1909.  Coitus  Decem- 
ber 28,  1909,  Girl  born  September  10,  1910;  expected  first  week  in 
October.     Period  due  January  1910  did  not  appear. 


212  THE  CAUSATION  OF  SEX 

The  above  is  a  case  of  pre-menstrual  fertilisation,  so  that 
the  shortly  expected  period — viz.  in  January — did  not 
appear.     A  girl  was  born. 

Somewhat  resembhng  the  pre-  and  post-menstrual  theory 
of  sex  causation  is  the  view  originated  by  Thury  of  Geneva; 
that  sex  was  due  to  a  difference  in  the  "  degree  of  ripeness  " 
of  the  ovum  when  fertilised. 

It  was  supposed  that  if  the  ovum  was  imperfectly  ripe 
when  fertilised  a  female  resulted;  if  quite  or  fully  ripe  or 
stale,  a  male  was  produced.  Further,  it  was  believed  that 
the  ovum  became  more  and  more  ripe  as  time  elapsed  be- 
tween its  leaving  the  ovary  and  its  becoming  fertilised^ 
that  is,  as  it  travelled  along  the  genital  tract  from  the 
ovary  to  the  uterus — so  that  an  ovum  fertilised  just  before 
or  a  very  short  time  after  being  shed  (ovulation)  was  supposed 
to  lead  always  to  a  female;  and  fertilisation  postponed 
several  days,  till  after  the  ovum  had  at  least  reached  the 
uterus,  led  always  to  a  male. 

That  is,  early  fertilisation  of  the  ovum  led  to  females, 
while  late  fertilisation  led  to  males;  hence  one  ovum  was 
supposed  to  be  able  to  produce  either  males  or  females. 

We  have,  however,  no  means  of  judging  of  the  "  ripeness  " 
of  an  ovum,  and  it  is  an  assumption  to  allege  that  a  lesser 
or  greater  degree  of  ripeness  (not  the  technical  maturation) 
is  acquired  by  the  ovum  on  its  journey  from  ovary  to 
uterus.  In  fact,  the  "  maturation  "  of  the  ovum  takes 
place  chiefly  in  the  Graafian  foUicle,  before  it  is  discharged 
therefrom. 

There  are  certainly  no  facts  to  show  that  an  ovum  is 
ever  shed  from  a  Graafian  follicle  in  the  ovary  until  it  is 
sufiiciently  ripe  for  fertilisation,  and  the  occurrence  of 
ovarian  pregnancy  _/);'ov^s  this  is  so;  for  the  ovum  is  actually 
fertilised  while  still  in  the  Graafian  foUicle,  and  we  have  no 
reason  to  believe  such  cases  are  necessarily  always  girls, 
as  they  should  be^if  early  fertilisation  leads  to  females 
always.  On  the  other  hand,  in  Chapter  IX.,  p.  74,  we 
have  three  cases  of  ovarian  pregnancy,  two  being  males 
and  one  female. 

We  know  pretty  well  that,  though  the  ovum  may  be 
fertiUsed  anywhere  in  the  genital  tract,  from  the  Graafian 


PRE-  AND  POST -MENSTRUAL  THEORY      213 

or  ovarian  follicle  down  to  the  lower  end  of  the  uterine 
cavity,  the  most  usual  site  of  fertilisation  is  the  outer  or 
expanded  portion  of  the  Fallopian  tube — i.e.  the  portion 
nearest  the  ovary.  And  thus,  not  having  travelled  far 
from  the  ovary  to  reach  this  part  of  the  Fallopian  tube,  the 
ovum  should  on  this  view  be  not  "  fully  ripe,"  so  that  most, 
if  not  all,  tubal  pregnancies  should  be  females,  which  they 
most  certainly  are  not;  as  well  as  a  goodly  proportion  of 
all  children,  as  the  tube  is  believed  to  be  the  usual  site  for 
fertilisation.  Male  children,  on  the  other  hand,  would 
arise  only  from  the  few  ova  which,  escaping  fertihsation  in 
the  Fallopian  tube,  had  become  "  fully  ripe  "  or  stale  by 
the  time  of  their  arrival  in  the  uterine  cavity,  and,  being 
fertilised  there,  should  give  rise  to  males  only.  Boys  would 
therefore  be  in  a  great  minority,  but  the  simple  fact  that 
everywhere  more  boys  are  always  born  than  girls  should 
surely  disprove  this  idea. 

Schroder  years  ago  collected  a  number  of  cases  of  preg- 
nancy where  the  women  knew  the  date  of  the  last  period, 
and  also  the  date  of  the  only  insemination.  He  found  that 
boys  were  conceived  on  an  average  10  days  after  menstrua- 
tion, and  girls  were  conceived  on  an  average  gf  days  after 
menstruation — i.e.  practically  an  identical  time.  So  these 
cases  disprove  both  Thury's  hypothesis  and  the  pre-  and 
post-menstruation  idea. 


CHAPTER  XXVI 

THE  DETERMINATION  OR  PRODUCTION  OF 
EITHER  SEX  AT  WILL 

From  what  has  been  shown  in  the  former  chapters  it  is 
abundantly  evident  that  the  production  of  either  sex  at 
will,  must  consist  in  avoiding  any  attempt  at  fertiHsation 
in  the  months  during  which  an  ovum  is  produced  of  the 
sex  which  is  not  desired. 

Hence  to  secure  a  different  sex  child  to  the  child  last 
born,  we  must  first  find  the  ovulation  month  of  the  last 
child — i.e.  the  month  during  which  the  ovum  shed  was 
fertilised,  according  to  the  rules  laid  down  in  the  last 
chapter. 

The  sex  being  already  known,  we  then  reckon  alternately 
month  by  month  and  so  find  the  months  which  correspond 
in  sex  to  the  one  which  provided  the  last  ovum;  during 
these  months,  therefore,  no  intercourse  must  take  place. 

If  fertilisation  then  ensues,  during  one  of  the  other 
months,  we  shall  certainly  obtain  a  child  of  the  opposite 
sex  to  that  last  born.  By  this  plan  I  have  been  able  to 
secure  to  many  members  of  the  nobility  and  aristocracy, 
etc.,  as  well  as  to  members  of  my  own  profession,  that  the 
birth  of  a  son  and  heir  shall  take  place — in  some  cases  on 
more  than  one  occasion — and  from  many  of  them  I  have 
received  letters  of  very  grateful  thanks. 

I  have  also  in  other  cases,  where  a  girl  was  desired,  in 
like  manner  correctly  determined  that  the  sex  of  the  next 
child  should  be  female  as  wished. 

I  have  besides  definite  evidence  that  readers  have  bene- 
fited by  the  book  and  correctly  determined  the  sex  of  their 
next  child  for  themselves;  though  doubtless  I  have  not 
heard  from  some  who,  through  want  of  appreciation  of 
some  of  the  difficulties,  have  failed  in  their  endeavour. 

.   214 


THE  DETERMINATION  OF  SEX  AT  WILL    215 

Much  of  the  unhappiness  in  Royal  and  other  houses  is 
due  to  a  certain  amount  of  ill-luck  or  misfortune  in  always 
unintentionally  catching  the  same  sex  ovulation. 

The  Empress  of  Russia  can  certainly  claim  to  have 
created  the  greatest,  even  international,  interest  as  to  the 
sex  of  her  coming  children.  It  was  always  reported,  and 
never  officially  contradicted,  that  the  Czarina,  after  con- 
sulting the  late  Professor  Schenk,  had  adopted  his  directions 
with  a  view  to  ensure  the  birth  of  a  son.  Hopeless  failure, 
however,  attended  these  efforts,  and  on  two  occasions  at 
least  a  daughter  was  born  instead  of  the  wished-f or  son,  who 
was  eventually  born  two  years  after  Professor  Schenk's  death. 

Why  the  Czarina  did  have  four  daughters  consecutively, 
and  at  last  a  son,  is  because  on  four  occasions  a  female 
ovulation  was  unfortunately  fertilised;  and  on  three  of 
these  occasions  this  could  have  been  easily  avoided  by 
calculating  on  my  method  the  sex  of  the  ovulation  month. 
The  sex  of  the  last  three  children  was  on  each  occasion 
foretold  correctly  by  me. 

The  Czarina  has  had  five  living  children,  thus : 

Princess  Olga,  born  November  15,  1895. 
Princess  Tatiana,  born  June  10,  1897. 
Princess  Marie,  born  June  26,  1899. 
Princess  Anastasia,  born  June  18,  1901. 
Prince  Alexis,  born  August  12,  1904. 

The  Czarina  gave  birth,  then,  to  a  girl  (Princess  Olga) 
on  November  15,  1895.  Tracing  back  280  days  or  40  weeks, 
we  find  that  the  ovulation  fertihsed  took  place  in  the  first 
week  of  February  1895;  so,  February  1895  being  a  female 
ovulation,  gave  rise  on  November  15,  1895,  to  the  birth  of 
a  girl,  Princess  Olga. 

The  next  child,  a  girl,  Princess  Tatiana,  was  born  in  June 
1897.  Now  40  weeks  back  make  the  ovulation  in  September 
1896.  As  February  1895  was  a  female  ovulation,  February 
1896  was  a  male  ovulation;  so  March  1896  would  be  a 
female,  April  a  male.  May  a  female,  June  a  male,  July  a 
female,  August  a  male;  and  September  1896  was  a  female 
ovulation,  therefore  a  girl  was  born  in  June  1897. 

The  third  child,  Princess  Marie,  was  born  in  June  1899, 


2i6  THE  CAUSATION  OF  SEX 

that  is,  the  same  month  two  years  later — the  sex,  as  I  have 
pointed  out  in  the  last  chapter,  being  therefore  the  same. 
The  ovulation  month  would  again  be  September  of  1898, 
and  as  September  1896  was  a  female  ovulation,  September 
1897  would  be  a  male,  and  September  1898  was  the  female 
ovulation  which  led  to  the  birth  of  Princess  Marie. 

Similarly,  Princess  Anastasia  was  born  in  the  same  month, 
June,  of  1901 — i.e.  two  years  after  Princess  Marie.  Here 
again  the  ovulation  month  would  be  September  of  1900; 
and  as  September  1898  was  a  female  ovulation,  September 
1899  would  be  a  male,  and  September  1900  a  female;  hence 
Princess  Anastasia  was  born. 

The  birth,  then,  of  these  three  princesses  successively 
after  the  first  is  thus  easily  accounted  for. 

The  long-wished-for  heir,  the  Cesarewitch,  was  born  in 
August  1904.  Tracing  back,  we  find  that  the  ovulation 
month  must  have  been  November  1903.  If,  therefore, 
September  1900  was  a  female  ovulation  period,  and  pro- 
duced the  Princess  Anastasia,  we  know  that  September  1901 
would  be  a  male,  September  1902  a  female,  and  September 
1903  a  male  ovulation  period;  therefore  October  1903  would 
be  a  female  ovulation,  and  November  1903  was  a  male 
ovulation,  which  being  fertilised,  the  long-looked-for  son 
and  heir  was  duly  born  in  August  1904,  his  birth  being  by 
this  plan  correctly  foretold  by  me. 

The  details  of  the  family  of  the  Queen  of  Spain  are  most 
interesting,  and  confirmatory  also. 

1.  Boy,  Prince  of  Asturias,  born  May  10,  1907. 

] 


1  R 

2.  Boy,  Prince  Jaime,  born  June  23,  1908.  4 

3.  Girl,  Princess  Beatrice,  born  June  22,  1909.  ^  ^    -^ 

4.  Boy,  premature  and  stillborn.  May  21,  1 9 10.    J    "1    r 


This  child  was  expected  in  June  1910. 
(See  note.) 

5.  Girl,  Princess  Maria,  born  December  12,  191 1 .  "1 

6.  Boy,  Prince  Juan,  born  June  20,  191 3-  J 

7.  Boy,  Prince  Gonzale,  born  October  24,  1914.  J^ 


'] 


The  Queen  of  Spain  gave  birth  to  a  boy  (Prince  of  Asturias) 
on  May  10,  1907.  Tracing  back  280  days,  or  40  weeks, 
we  find  the  ovulation  fertihsed  was  in  the  first  week  of 
August  1906,  and,  being  a  male,  gave  rise  on  May  10,  1907, 
to  the  birth  of  a  son,  the  Prince  of  Asturias. 


THE  DETERMINATION  OF  SEX  AT  WILL    217 

The  next  child,  a  boy,  Prince  Jaime,  was  born  June  23, 
1908,  and  40  weeks  back  makes  the  ovulation  in  September 
1907.  As  August  1906  was  a  male  ovulation,  August  1907 
was  a  female  ovulation,  so  the  next  month,  September 
1907,  would  be  the  male  ovulation,  and  therefrom  a  boy, 
Prince  Jaime,  was  born  in  June  1908. 

Similarly,  the  next  child,  a  girl,  Princess  Beatrice,  being 
born  in  the  same  month  (June)  of  the  next  year  means  that 
the  September  ovulation  of  the  year  following  to  that 
which  gave  rise  to  Prince  Jaime,  being  fertilised,  a  girl 
resulted;  for  September  1907  being  a  male  ovulation, 
September  1908  would  be  a  female,  and  the  Princess  was 
born  in  June  1909. 

The  next  child  (No.  4)  was  prematurely  born  dead. 
Here  again  the  child  was  expected  in  June  1910,  and  had 
he  been  born  then  would  have  likewise  supported  my 
theory.  His  birth  in  May  1910,  however,  comes  wrong 
from  the  dates  of  Princess  Beatrice,  and,  as  pointed  out 
in  the  previous  chapter,  this  premature  and  immature 
birth  so  upset  and  interfered  with  the  normal  ovulation 
rhythm  that  the  next  children  also  come  wrong.  Princess 
Maria  coming  wrong  from  No.  4;  and  Princes  Juan  and 
Gonzale  coming  wrong  from  Princess  Maria  and  each  other, 
as  well  as  from  either  Prince  Jaime  or  Princess  Beatrice. 

The  case  furnishes  a  very  good  example,  in  the  first 
three  children,  of  the  accuracy  of  the  theory,  besides  being 
an  example  of  how  premature  births  upset  the  rhythm 
and  calculations  for  subsequent  ones. 

Note. — On  February  i,  1910,  a  statement  appeared  in  the  London 
newspapers  that  the  accouchement  of  the  Queen  of  Spain  was  ex- 
pected in  May  1910.  On  the  strength  of  that  statement  I  foretold 
to  many  that  the  child  would  be  a  girl  in  May. 

On  May  16,  1910,  there  appeared  an  announcement  from  the 
Madrid  official  journal  that  "  Queen  Victoria  Eugenie's  confinement 
is  expected  in  about  a  month's  time."  I  therefore  corrected  my 
prophecy  to  the  child  being  a  boy,  if  born  in  June  1910;  as  I  should 
have  originally  predicted  had  the  month  of  birth  been  given  as  June. 
Why  the  child  was  prematurely  stillborn  in  May,  so  making  my 
prophecy  and  my  theory  look  incorrect,  I  now  propose  to  show. 

At  midnight  on  May  6,  1910,  the  Queen  of  Spain's  uncle,  King 
Edward  VII.  died  unexpectedly,  and  there  can  be  little  doubt  that 
the  shock  of  this  news,  together  with  the  hurried  departure  for 


2i8  THE  CAUSATION  OF  SEX 

England  af  her  mother,  the  Princess  Henry  of  Battenberg,  and 
later  of  her  husband,  the  King  of  Spain,  leaving  her  quite  alone 
(for  she  had  not  even  her  English  nurse  near  her),  combined  to 
upset  her  and  killed  the  child;  for  unexpected  premature  labour 
pains  set  in  on  May  18,  though  we  had  only  just  read  in  the  papers 
of  May  16  that  labour  was  "  expected  in  about  a  month's  time." 
The  funeral  of  her  uncle.  King  Edward  VII.,  was  on  May  20,  and  she 
was  confined  at  2.30  a.m..  May  21,  1910,  of  a  stillborn  male  child, 
though  "  the  accouchement  had  been  normal,  without  complication," 
showing  it  was  not  the  labour  which  had  killed  the  child,  but  the 
death  of  the  child  had  induced  the  onset  of  labour. 

The  English  nurse,  who  would  most  certainly  have  been  in  readi- 
ness and  waiting  had  the  confinement  been  then  expected,  after 
evidently  being  hurriedly  sent  for  when  the  pains  started,  as  re- 
corded on  May  18, — "  arrived  on  the  night  of  the  20th  " — i.e.,  a  few 
hours  only  before  the  birth,  in  the  early  morning  of  May  21,  1910. 

That  this  child  (a  boy)  was  prematurely  born  in  May,  though  not 
expected  till  June,  is  evident  by — 

(a)  The  statement  in  the  Madrid  official  journal  that  the  confine- 
ment was  due  about  a  month  later  than  May  15-16 — i.e.,  mid-June 
1910. 

(b)  The  fact  that  the  child  was  stillborn  though  the  labour  was 
normal  and  uncomplicated, 

(c)  The  absence  of  her  English  nurse,  who  would  certainly  have 
been  sent  for,  and  kept  in  Madrid  in  readiness,  if  the  labour  had 
been  expected  when  it  took  place.  Her  distance  of  living  from  her 
case  would  have  been  a  reason  for  having  her  at  hand,  as  is  done 
by  many  ladies,  a  week  or  more  before  the  expected  date  of  con- 
finement. 

{d)  It  is  probable  that  her  mother  and  husband  would  not  both 
have  left  her  had  the  confinement  been  due  when  it  actually  took 
place. 

Taking  these  things  into  consideration,  I  have  no  hesitation  in 
saying  that  the  Queen  of  Spain's  fourth  child,  a  male,  stillborn 
on  May  21,  19 10,  was  prematurely  born,  and  was  not  really  due  till 
June  1910.  And  so  the  case  further  supports  my  theory,  and  my 
forecast  was  essentially  correct — viz.,  a  female,  if  full  time,  in  May, 
and  consequently  a  male  in  June. 

We  may  possibly  some  day,  by  means  of  some  modifica- 
tion of  the  Rontgen  or  other  rays,  be  able  to  actually  see 
an  ovary  ovulate.  This  should  not  sound  so  improbable 
when  we  recall  how  impossible  the  location  of  swallowed 
objects,  bullets,  and  other  foreign  bodies,  besides  views  of 
fractured  bones,  would  have  been  thought  before  the 
discovery  of  the  Rontgen  rays. 

Efforts  are  even  now  being  made  to  show  the  action  of 


THE  DETERMINATION  OF  SEX  AT  WILL    219 

the  heart  in  situ;  and  who  can  say  that  an  ovary  ovulating 
will  be  an  impossible  view  in  the  future  ? 

If  this  ever  comes  to  pass,  the  solving  of  the  problem 
how  a  Royal  house  would  be  able  to  avoid  the  birth  of  a 
princess  when  a  prince  was  wanted,  would  be  rendered 
quite  easy ;  it  would  allow  even  the  first  child  to  be  a  boy 
if  so  desired.  Until  the  right  or  male  ovary  was  seen  to 
ovulate,  sexual  congress  would  be  prohibited;  then,  if 
fertilisation  followed,  the  desired  prince  would  be  born. 
There  are  still  many  houses  awaiting  such  an  event  with 
anxiety. 

Until  such  time,  therefore,  as  we  can  see  an  ovary  ovulate, 
we  must  be  content  to  work  out,  from  the  data  of  a  previous 
child's  birth,  which  ovary  is  working  during  certain  months. 

This  plan,  I  maintain,  succeeds  for  births  after  the  first ; 
but  I  am  quite  unable  to  determine  the  sex  of  the  firstborn. 

But  this  matters  only  slightly;  it  is  only  after  the  birth 
of  at  least  one  child  that  the  parents  begin  to  wish  for  a 
child  of  different  sex.  This,  my  plan  now  teaches  them 
how  to  achieve,  though  there  are  several  pitfalls  for  the 
amateur  sex  determinator. 


INDEX 


Abdul-Hamid,  71. 

Abernethy.  100, 

Addinsell,  A.  W.,  24,  26. 

Adhesions,  absorption  of,  131. 

—  render    removal    of    ovary    or 

tumour   difficult   or   incomplete, 

73.  168. 
Adverse  cases,  so-called,  157. 
Ages,  relative,  of  parents  theory,  52. 

disproved,  123. 

Albertus  Magnus,  54,  115. 

Alecithal  ova,  35. 

AnaboHsm,  52. 

Anaxagoras,  54. 

Anderson,  Wm.,  108. 

Andrews,  H.  Russell,  69,   71,   148, 

152. 
Animals,  offspring  of,  all  one  sex, 

61,  62. 
Artifacts,  31. 
Avicenna,  54.  115. 

Baldwin,  158,  161. 

Ballantyne,  J.  W.,  39,  42,  150,  151, 

157,  159,  161,  163,  T71. 
Barker,  Fordyce,  83. 
Barnes,  R.,  91. 
Bate,  G.,  138. 
Baudouin,  141,  144. 
Beigel,  161. 
Berner  and  Stieda,  53. 
Bernutz  and  Goupil,  74. 
Bertillon,  113. 
Billroth,  178. 
Birnbaum,  134,  152. 
Birth-rate  of  boys  and  girls,    105, 

171. 
Bischolf,  90,  100. 
Blacker,  G.  F.,  154. 
Bland-Sutton,  Sir  J.,  21,  26.  51.  68, 

86,  88,  91,  94,  126,  154,  162-166, 

178. 
Blomfield,  J.  E.,  151. 
Bonamy  and  Beau,  109. 
Bond,  C.  J.,  150. 
Boxall,  R.,  92. 
Boyd,  Mrs.  Stanley,  73,  81,  131. 


Boys,  birth-rate  of,  105,  171. 

—  due  to  right-sided  ova,  54. 
to  spermatozoa,  54. 

—  more  than  girls  in  sextuplets,  141. 

—  — in  triplets,  139. 

j   —  one,    followed   by   several   girls,' 

I        129- 

—  only  in  family,  128. 

— •  proportion    of    illegitimate,    to 
girls,  113. 

—  proportion  of  stillborn,  to  girls, 
106. 

—  several,  followed  by  one  girl,  130. 

—  twin,  no. 

—  twin,  more  numerous  than  girl 
twins,  133. 

—  why  more  than  girls,  105, 
Braun,  Von,  119. 

Breasts  alternately  painful,  176. 

—  abscesses  of,  178. 
Bryce,  38. 
Burdach,  53. 

Campbell,  H.,  106. 

Canestrini,  52. 

Carpenter,  W.  C,  61. 

Castration,  incomplete,  of  cockerels, 
168. 

Children,  all  one  sex,  127. 

after  unilateral  ovario- 
tomy, 76. 

by   different   men,    58, 

59. 

—  different  sex  by  different  wives 
of  one  husband,  59,  60. 

—  diseased,  due  to  a  diseased  ovary 
or  ova,  146. 

—  of  alternate  sex  in  one  family, 
123. 

—  of  Czarina,  215. 

—  of  one  sex  only,  diseased,  146. 
• monstrosities,  151. 

—  sequences  of,  of  same  sex,.  128. 
Churchill,  133. 

Colour  blindness,  153. 

—  of  hair  identical  in  uniovular 
twins,  136. 


222 


THE  CAUSATION  OF  SEX 


Conceptions,    male   exceed   female, 
io6. 

—  multiple,  132. 
Condamin,  166. 
Cornual  pregnancy,  84. 

Corpora  lutea  in  rabbits'   ovaries, 

100. 

in  sows'  ovaries,  137. 

scars  from,  equal  the  number 

of  menstrual  periods,  49,  50. 

two  in  one  ovary,  134,  153. 

Corpus  luteum,  19 

after  removal  of  both  ovaries, 

165. 

due  to  fibroids,  87. 

in  monotocous  animals,  loi. 

in    polytocous    animals,    51, 

103. 

• ma  tubal  fringe,  167. 

in  tubal  abortion,  88. 

sign  of  previous  ovulation,  20, 

86. 

true,  a  sign  of  pregnancy,  86. 

Cory,  Robert,  23. 

Cow,  calves  of  a,  all  one  sex,  62. 

—  pregnant  uterus  of,  loi. 
Cripps,  H.,  92. 

Croom,  J.  H.,  158. 

Cullingworth,  C.  J..  68,  70.  72,  87, 

92,  164. 
Cunningham,  8,  41. 
Czarina's  children,  215. 

Dauber,  J.  H.,  159- 

Dawson,  E.  Rumley,  54,  63,  67,  131. 

Death-rate  in  boys  and  girls,  106. 

Decubitus  and  sex,  115. 

Dermoids,  166. 

Determination,  the,  of  sex,  214. 

Deutoplasm,  35. 

Dix,  W.  R.,  144. 

Doncaster,  L.,  103,  201. 

Doran,  Alban,  29,  79,  93.  I57.  162, 

164,  169. 
Dorland,  118. 
Double  uterus,  83. 
Drennan,  T.  G.,  177. 
Duncan,  Wm.,  68. 
Dyball,  B.,  68. 

Eden,  T.  W.,  39,  167- 

Ellis,  Havelock,  55,  105,  153. 

Emmett,  T.  A.,  171. 

Endometrium,  23. 

Engel,  170. 

Esquimaux,  ovulation  in,  arrested 

by  cold,  29,  30. 
Etchecoin,  140. 
Evans,  J.  H.,  152. 
External  migration  of  ovum,  90. 
Extra-uterine  pregnancies,  67. 


Fallopian  tubes,  1 1 . 

—  ■ —  function  of,  12. 

length,  abnormal,  of,  94. 

lie  on  different  levels,  6,  1 1 1 . 

misplaced,  94. 

mobility  of,  11,  93. 

receptacles  for  semen,  44,  iii. 

Family,  normal,  contains  both  sexed 

children,  115. 
Farre,  99. 

Father  does  not  cause  sex,  47,  56. 
Fertilisation,  38. 

—  due  to  father  only,  58. 

—  in  invertebrate,  40. 

—  not  observed  in  mankind,  39. 

—  number  of  spermatozoa  requisite 
for  human,  39. 

—  pre-  and  post-menstrual,  208. 

—  site  of,  43.  95- 
Fordyce  Barker,  83. 
Forecasting  sex  of  unborn  child,  181. 
Free-martin,  155. 

Freureisz,  139. 

Galabin,  A.  L.,  87,  91,  no,  126,  162, 

166. 
Galen,  48,  54. 
Garrigues,  H.  J.,  7,  8,  12,  17,  43,  44, 

51,  100,  no,  132,  175. 
Geddes  and  Thomson,  23,  52. 
Germinal  spot,  16,  34. 

—  vesicle,  16,  34. 
Gerrish,  9,  41,  66,  127. 
Giles,  A.  E.,  82,  94. 
Girdwood,  50. 

Girls,  illegitimate,  proportion  of,  to 
boys,  113. 

—  and  girl  twins,  137. 

—  one,    followed  by   several  boys, 
129. 

—  only  in  family,  128. 

—  proportion  of  stillborn,  106. 

—  several,  followed    by    one    boy, 
130. 

Girou,  53. 
Glockner,  95. 
Gowers,  Sir  Wm.,  104. 
Graaf,  R.  de,  14. 
Graafian  follicle,  14,  15. 

—  containing  two  ova,  16,  135,  138. 

—  contents  of,  16. 

—  number  of,  14,  28,  32. 

—  rupture  of  a,  18. 
Grimsdale,  T.  B.,  17. 

Halliburton,  W.  D.,  17,  32,  43,  127, 

128. 
Handfield- Jones,  M.,  83. 
Hann,  R.  G.,  26. 
Hart,  B.,  11,  109,  135. 

—  and  Barbour,  7,  125,  131. 


INDEX 


223 


Heape,  24,  52,  179. 

Hegar,  151. 

Heil,  Karl,  23. 

Heisler,  J.  C.  16,  17,  26,  27,  42. 

Hellier,  J.  B.,  71. 

Hellin,  143. 

Hencke,  48,  54. 

Heredity  due  to  both  parents,  58. 

Herff,  von,  136. 

Herman,  G.  E.,  21,  48,  65,  87,  91, 

94,  131,  166. 
Hermaphroditism,  154. 
Hippocrates,  47,  54. 
Hirst,  B.  C,  19.  86,  90,  135. 
Hof acker  and  Sadler,  53. 
Holoblastic  ovum,  40. 
Homologous  twins,  135. 
—  often  conjoined,  138. 
Horrocks,  P.,  24,  31. 
Hurst,  C.  C,  201. 
Hutchinson,  Sir  J.,  72. 
Hutchison,  R.,  152. 

Illegitimacy,  112. 

Inflammation    of    Fallopian   tube, 

124. 
Internal  migration  of  ovum,  90,  95. 

Jardine,  R.,  22. 

Jellett,  H.,  22. 

Jewett,  no,  133. 

Jews,  male  birth-rate  of,  112. 

Johnstone,  A.,  98. 

Jones,  Mary  Dixon,  150. 

Jurinka,  83,  171. 

Katabolism,  52. 

Kelly,  Howard,  85,  92,  94. 

Keraval,  146. 

Knight,  61. 

Kossmann,  152. 

Krusen,  W.,  139. 

Kussmaul,  90,  96. 

Lactation,  unilateral,  177. 
Lee,  R.,  51. 
Leeuwenhoek,  47. 
Lefas,  167. 

Left  side  of  body  weaker  than  right, 
48. 

—  ovary  smaller  than  right,  12,  108, 

—  ova  are  female,  48,  57. 
Leguen,  177. 
Lenhossek,  57. 
Leopold,  30. 

Lewers,  A.  H.,  68,  69,  81,  84. 
Liquor  folliculi,  14. 
Lockyer,  C,  152,  162,  171. 
Lode,  142. 
Lusk,  83,  135. 


McKerron,  R.  G.,  78. 
Macnaughton-Jones,  H.,  22,  64,  78. 
Magnus,  Albertus,  54,  115. 
Malcolm,  J.  D.,  169. 
Man  does  not  cause  sex,  47,  56,  58. 
Manton,  W.  P.,  163. 
Marchand,  F.,  152. 
Mare's  foals  all  one  sex,  62. 
Marshall,  F.  H.,  24. 
Mathew,  Porter,  no. 
Mayerhofer,  53. 
Menopause,  22, 

—  haemorrhage  after,  30. 

—  pregnancy  after,  26. 
Menstruation,  22. 

—  alternate,     indicates     alternate 
ovulation,  171. 

good  and  bad  periods,  171. 

—  dependent  on  ovarian  tissue,  31, 
165,  167. 

—  number  of  periods  equalled  by 
number  of  ovulation  scars,  50. 

—  phenomena  of,  24. 

—  pregnancy  prior  to  onset  of,  26 

—  prolonged,  23. 

—  stopped  by  Arctic  cold,  29. 
Meredith,  W.  A.,  64. 
Meroblastic  ovum,  40. 
Micropyle,  34,  41. 
Migration  of  ovum,  45,  90. 
Milander,  126. 

Millot,  115. 

Monorchids,  60. 

Montgomery,   W.  F.,    n,   66,    135, 

137- 
Moorhead,  T.  G.,  7,  49. 
Morgagni,  167. 
Morris,  H.,  12. 
Multiple  pregnancy,  132, 

due  to  mother,  143. 

Mylvaganam,  H.  B.,  79. 

Nagel,  136,  156. 

Napheys,  G.  H.,  144. 

N^grier,  49,  170. 

Nijhoff,  141. 

Norris  and  Dickinson,  136. 

Nuclei,  two  in  one  ovum,  135. 

Nucleoli,  two  in  one  nucleus,  136 

Nucleolus,  16,  35. 

Nucleus  of  ovum,  16,  34. 

—  double,  16. 

—  fertilisation  of,  35,  45. 

Offspring   all   same    sex   in   quad- 
rupeds. 61. 
Ollivier,  83. 
Olshausen,  80,  164. 
Oocyte,  16,  17,  32. 
Oosperm,  38. 

—  site  of  attachment,  44, 


224 


THE  CAUSATION  OF  SEX 


Opitz,  69. 

Ovarian  follicle.     Cf.  Graafian  fol- 
licle. 

—  pregnancy,  74. 

—  tissue,  160. 

in  ovarian  ligament,  157,  163. 

in   between  layers   of   broad 

ligament,  160,  161. 
small  piece  can  ovulate,  166, 

167. 
unremoved       portions       of, 

growth  of,  168. 

leading  to  pregnancy,  164. 

to  tumours,  169. 

Ovaries,  absence  of  one,  126. 

—  accessory,  161,  163. 

—  adhesions  cause  incomplete  re- 
moval of,  168. 

—  alternate  action  of,  49,  51,  170. 

—  anatomy  of,  12. 

—  bilateral  removal,  effects  of,  80. 

—  cirrhosis  of,  126. 

—  containing    two    corpora    lutea, 

134.  ^5Z- 

—  diseased,  146. 

—  essential  factor  in  causation  of 
sex,  46. 

—  growth   of   unremoved  portions 
of,  168. 

—  ovulation  from,  17,  28,  166,  170. 
scars  in.  29. 

—  pregnancy  in,  74. 

—  resection  of,  80,  168. 

—  right  larger  than  left,  12,  108. 
provides  male  ova,  47,  108. 

—  rudimentary  condition  of,  125. 

—  unequal  size  of,  12,  108. 
Ovariotom5^  bilateral,  80. 

—  effects  of,  on  child-bearing,  76. 

—  growth  of  tumour  after,  168. 

—  incomplete,  164,  165,  168. 

—  pregnancy  after,  164. 

—  unilateral,       causes       unilateral 
sterility,  127. 

Oviduct.  Cf.  Fallopian  tube. 
Ovisac.  Cf.  Graafian  follicle. 
Ovulation,  17,  166,  170. 

—  alter  removal  of  one  ovary,  180. 

—  alternate,  49,  51,  170. 

— •  occurs    about    the    time    of    a 
menstrual  period,  28. 

—  precedes  menstruation,  177. 

—  scars   of,    equal    to    number   of 
periods,  29.  49,  50,  51. 

—  stopped  by  Arctic  cold,  29. 

—  unilateral,  49,  170. 

in   monotocous   animals,    52, 

179. 

—  withovit  menstruation,  27. 
Ovum.  15,  16,  30,  38. 

—  alecithal,  35. 


Ovum  determines  the  sex,  48,  57. 

—  embedding  of,  44,  99. 

—  fertilisation  of,  38,  58. 

—  formation  of,  32. 

—  holoblastic,  40. 

—  human,  34. 

—  invertebrates,  41. 

—  meroblastic,  40. 

—  migration  of,  43,  90. 

—  Peters',  38. 

—  sex  of,  33,  47,  57. 

—  structure  of,  33. 

—  telolecithal,  35. 

—  transmigration  of,  90. 

—  with  two  nuclei,  135. 

—  yolk  of,  35. 

Parry,  89. 

Parvin,  7,  80,  108,'  no. 

Peri  vitelline  fluid,  33. 

—  space,  33. 

Peters,  Hubert,  ovum  of,  38. 

Phillips,  J.,  51. 

Piersol,  14,  21,  108,  135. 

Pinard  and  Magnan,  106. 

Pinesse,  165. 

Placental  site,  44,  119. 

Playfair,  W.  S.,  6,  19,  no,  132-136. 

Plural  pregnancy,  132,  142. 

Pocock,  67. 

Pollock,  R.,  95- 

Polyspermy,  41,  43. 

—  sex  due  to,  52. 
Popow,  87. 
Power,  John,  23. 
Prediction  of  sex,  181. 

—  difficulties  and  errors  in,  197. 
Pregnancy  after  double  ovariotomv, 

80.  164. 

menopause,  26. 

unilateral  ovariotomy,  76. 

—  and  dermoids,  166. 

—  cases   of   repeated   plural,    143, 
144. 

—  corpus  luteum  sign  of,  86. 

—  duration  of,  183. 

—  in  abnormal  uteri,  82. 

—  in  cow,  loi. 

—  in  mammalia,  97. 

—  in  rudimentary  cornu,  84. 

—  in  sheep,  103. 

—  multiple,  in  rabbits,  etc.,  100. 

—  ovarian,  74,  75. 

—  plural,  132,  142. 

due  to  woman,  142. 

repeated,  143,  144. 

—  prior  to  menstruation,  26. 

—  tubal,  67  et  seq. 

Pre-  and  post-maturity,  197,  203. 
Pre-  and  post-menstruation  theory 
of  sex  determination,  208. 


INDEX 


225 


Puberty,  20. 
Puech,  142. 

<3uadruplets,  140. 
Quintuplets,  141. 

Ratcliffe,  J.  R.,  loi. 

Rauber,  112. 

Raviart,  146. 

Rectum,  7. 

Reeves,  H.  A.,  75,  126. 

Reichert,  35. 

Remfrey,  L.,  23,  27. 

Richet,  9,  96. 

Right  ovary  larger  than  left,  12, 108. 

—  ova  are  male,  48,  57. 
Roberts,  Lloyd,  141,  143. 
Robin,  53. 

Robinson,  Byron,  93. 

Romme,  53. 

Ross,  J.,  52. 

Routh,  Amand,  65,  68,  77,  165,  168. 

Rumpe,  no,  133. 

Russia,  Empress  of,  children  of,  215. 

Ruth,  73. 

Sadler,  53. 

Saleeby,  C.  W.,  106. 

Salpingitis,  125. 

Saniter,  138. 

Schenk,  113,  215. 

Schroeder,  135. 

Scott,  Michael,  54. 

Sea-urchins,  40, 

Sehgson,  74. 

Sex,  determination  of,  214. 

—  due  to  age  of  parents,  53. 

to  spermatozoa,  52,  54. 

to  vigour  of  parents,  53. 

to  woman  only,  47,  58. 

—  families  of  children  all  the  same, 
127,  128. 

—  prediction  of,  181. 
of  twins,  191. 

Sexes,  proportion  of,  in  individual 

families,  122. 
Sexify,  47,  58. 
Sextuplets,  141. 
Slamjer,  71. 
Smith,  A.,  73. 
Smith,  Sir  T.  R.,  84. 
Snow,  L.  M.,  180, 
Spain,  Queen  of,  children  of,  216. 
Spencer,  H.  R.,  64,  126,  168. 
Spermatozoa,  36. 

—  do  not  influence  sex,  47,  48,  57. 

—  how  they  enter  the  ovum,  37,  41. 

—  motility  of,  37,  117, 

—  number  requisite  for  fertilisation 
in  invertebrates,  34,  39. 

—  source  of,  36. 


Spiegelberg,  7,  20,  117. 

Starfish,  41. 

Sterility,  causes  of,  125. 

—  unilateral,  124. 
Stevens,  T.  G.,  12,  14,  22,  25. 
Stieda,  53. 

Stillbirth,  106. 

Stillborn   boys,    proportion   of,    to- 

girls,  106. 
Strassmann,  24,  29,  171. 
Stretton,  L.,  73. 
Striae  of  zona  pellucida,  33,  41. 

functions  of,  41. 

Sturmer,  A.  J.,  69. 

Sutton,  Bland,     Cf.  Bland-Sutton. 

Sutton,  Stansbury,  159. 

Tait,  Lawson,  72. 
Targett.  J.  H.,  77,  84. 
Tarnier  and  Budin,  148. 
Taylor,  J.  W..  69. 
Teacher,  J.,  38,  42. 
Temesvary,  26,  176. 
Testicles,     growth    of    unremoved 
portions  of,  in  cockerels,  168. 

—  congenital  absence  of  one,  60. 

—  removal  of  one,  affects  not  the 
sex  of  offspring,  62. 

Theory,  the,  46. 

—  proved  by  pregnancy  in  ab- 
normal uteri,  82. 

in  normal  uteri,  63. 

by  extra-uterine  pregnancy, 

67. 
by  ovarian   pregnancy,    74, 

75- 

by  tubal  pregnancy,  67. 

Thompson,  G.  W.,  139. 

Thury,  212. 

Tilt,  E.  J..  22,  30,  176. 

Transmigration  of  ovum,  90. 

Triplets,  138. 

Tubal  pregnancy,  67. 

repeated,  69. 

Tubby,  A.  H.,  153. 
Tuckey,  P.,  53,  118. 
Tufnell,  63,  134. 
Tumour,  dermoid,  166. 

—  growth  of  ovarian,  after  double 
ovariotomy,  168. 

—  incomplete  removal  of,  due  to 
adhesions,  169. 

—  removal  of,  not  synonymous  with 
removal  of  all  ovarian  tissue,  81, 
162,  i6g. 

Twins,  132. 

—  binovular,  132,  133. 

—  boy  and  girl,  137. 

—  conjoined,  135. 

—  followed  by  child  of  opposite  sex, 
130. 


21^6 


THE  CAUSATION  OF  SEX 


Twins,  forecasting  sex  of,  191. 

—  homologous,  t/^/ identical,  135. 

—  impotency  of,  155. 

—  insanity  in,  146, 

—  male  more  numerous  than  fe- 
male, 109. 

—  pigeon-pair,  137. 

—  sex  of,  137. 

—  uniovular,  135. 

—  varieties  of,  133. 

Unilateral  sterility,  124. 
Uniovular  quadruplets,  140. 

—  triplets,  138. 
Uterus,  abnormal,  10,  82. 

—  anatomy  of,  5. 

—  cavity  of,  9. 

—  cervix  of,  6,  9. 

—  cornu  of,  9,  82. 

—  double,  83. 

—  function  of,  10. 

—  horns  of,  9,  82. 

—  internal  diameter  of,  9,  96. 

—  mammalian,  98. 

—  posterior  view  of,  116. 

—  relations  of,  7,  8. 

—  sheep's,  97. 

—  two  halves  of,  menstruate  alter- 
nately, 170. 


Van  Lint,  53, 
Veit,  no,  132. 
Vigour,  relative,  of  parents  theory, 

53- 

disproved,  123. 

Vilson,  53. 

Vitelline  membrane.  33, 
Voron,  139. 
Vortisch,  143. 

Waldeyer,  135. 

Walls,  W.  K.,  83. 

Walter,  W.,  158. 

Warnek,  73. 

Webster,  Clarence,  108. 

Wetherell,  J.  A.,  76. 

White,  C,  141. 

WilUams,  Whitridge,  14.  20,  21,  28., 

30,  38,  88,  91.  136,  138. 
Williamson,  H.,  84,  92. 
Will-JiU,  154. 

Willoughby,  Sir  Francis,  128. 
Wilson,  Andrew,  52. 

—  Thomas,  94,  136. 

Zona  pellucida,  33. 

give  the  spermatozoa  access  to 

ovum,  42. 

—  striata,  33. 


H.    K, 


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